Provider Demographics
NPI:1114017332
Name:OLSON, DAWN FLORINE (DN)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:FLORINE
Last Name:OLSON
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 S NAPERVILLE RD
Mailing Address - Street 2:#207
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-8192
Mailing Address - Country:US
Mailing Address - Phone:773-501-5071
Mailing Address - Fax:630-752-1222
Practice Address - Street 1:4711 GOLF RD STE 414
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1242
Practice Address - Country:US
Practice Address - Phone:773-501-5071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181000312172P00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1634311OtherBCBS PROVIDER NUMBER
IL200698283OtherEIN #