MEDICARE: HANNAH BROOKE OLSEN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1447101589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH BROOKE OLSEN PA-C

Provider Business Mailing Address
First Line	:	700 N MAIN ST UNIT F1
Second Line	:
City	:	WASHINGTON
State	:	UT
Zip	:	84780-2454
Country	:	US
Telephone Number	:	435-229-6860
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 N MAIN ST UNIT F1
Second Line	:
City	:	WASHINGTON
State	:	UT
Zip	:	84780-2454
Country	:	US
Telephone Number	:	435-229-6860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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