Provider Demographics
NPI:1134143175
Name:OLSON, GAIL MAE (MD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:MAE
Last Name:OLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 MILL ST W
Mailing Address - Street 2:
Mailing Address - City:CANNON FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:55009-1824
Mailing Address - Country:US
Mailing Address - Phone:507-263-3951
Mailing Address - Fax:507-263-7652
Practice Address - Street 1:1116 MILL ST W
Practice Address - Street 2:
Practice Address - City:CANNON FALLS
Practice Address - State:MN
Practice Address - Zip Code:55009-1824
Practice Address - Country:US
Practice Address - Phone:507-263-3951
Practice Address - Fax:507-263-7652
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN88G16OLOtherBC/BS
MNHP16894OtherHEALTH PARTNERS
MNMH1481000589OtherPREFERRED ONE
MN009368800Medicaid
MN0129560OtherMEDICA CHOICE
MN120427OtherUCARE
MN0129560OtherMEDICA CHOICE
MNMH1481000589OtherPREFERRED ONE