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NPI Code Detail

MEDICARE: DR. BERNADETTE LOUISE OLSON ATC, AT

MEDICARE: DR. BERNADETTE LOUISE OLSON ATC, AT
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
12255A2300XAthletic Trainer0059SD

General Provider Information

NPI Number : 1679534192
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BERNADETTE LOUISE OLSON ATC, AT
Provider Business Mailing Address
First Line : 460 DEEP CREEK RD
Second Line :
City : MANHATTAN
State : KS
Zip : 66502-9240
Country : US
Telephone Number : 605-691-0914
Fax Number :
Provider Business Practice Location Address
First Line : 1105 SUNSET AVE
Second Line :
City : MANHATTAN
State : KS
Zip : 66502-3739
Country : US
Telephone Number : 605-691-0914
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2006
Last Update Date : 09/13/2024

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