MEDICARE: DR. SHARON L OLSON PH.D. APRN

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	363L00000X	Nurse Practitioner	SO153255	MI

General Provider Information

NPI Number	:	1720092430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARON L OLSON PH.D. APRN

Provider Business Mailing Address
First Line	:	PO BOX 55
Second Line	:
City	:	OLD MISSION
State	:	MI
Zip	:	49673-0055
Country	:	US
Telephone Number	:	231-223-9299
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 E 8TH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-2630
Country	:	US
Telephone Number	:	231-929-2900
Fax Number	:

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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