MEDICARE: MR. PAUL STEVEN OLAVSON 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1386544500	UT

General Provider Information

NPI Number	:	1770560690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL STEVEN OLAVSON APRN

Provider Business Mailing Address
First Line	:	1020 S MAIN ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84101-3176
Country	:	US
Telephone Number	:	801-539-7000
Fax Number	:	801-539-7076

Provider Business Practice Location Address
First Line	:	1020 S MAIN ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84101-3176
Country	:	US
Telephone Number	:	801-539-7000
Fax Number	:	801-539-7076

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	07/08/2007

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