MEDICARE: JENNIFER JEAN OLSON MD

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	207Q00000X	Family Medicine Physician	200200974	NC

General Provider Information

NPI Number	:	1659378909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JEAN OLSON MD

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1965 S US 29 HWY
Second Line	:
City	:	CHINA GROVE
State	:	NC
Zip	:	28023-5684
Country	:	US
Telephone Number	:	704-855-8338
Fax Number	:	704-855-8339

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	08/16/2022

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