MEDICARE: HUNTER OLSON RN

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	163WM0705X	Medical-Surgical Registered Nurse	201908009RN	OR

General Provider Information

NPI Number	:	1871108522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUNTER OLSON RN

Provider Business Mailing Address
First Line	:	2004 N 24TH ST APT 1
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-2791
Country	:	US
Telephone Number	:	314-620-4995
Fax Number	:

Provider Business Practice Location Address
First Line	:	2004 N 24TH ST APT 1
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-2791
Country	:	US
Telephone Number	:	314-620-4995
Fax Number	:

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

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	09/10/2020

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