Provider Demographics
NPI:1164674354
Name:OLSON, SANDRA LEA (RN)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LEA
Last Name:OLSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2442
Mailing Address - Street 2:
Mailing Address - City:COLSTRIP
Mailing Address - State:MT
Mailing Address - Zip Code:59323-2442
Mailing Address - Country:US
Mailing Address - Phone:406-748-3423
Mailing Address - Fax:
Practice Address - Street 1:100 CHEYENNE AVENUE
Practice Address - Street 2:
Practice Address - City:LAME DEER
Practice Address - State:MT
Practice Address - Zip Code:59043-0070
Practice Address - Country:US
Practice Address - Phone:406-477-4474
Practice Address - Fax:406-477-8848
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN24877163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTRN24877OtherNURSING LICENSE