Provider Demographics
NPI:1225387491
Name:OLSEN, CLINTON D (DNP, NP-C)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:D
Last Name:OLSEN
Suffix:
Gender:M
Credentials:DNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 RIVER PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5764
Mailing Address - Country:US
Mailing Address - Phone:801-223-4860
Mailing Address - Fax:801-371-8993
Practice Address - Street 1:280 W RIVER PARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5793
Practice Address - Country:US
Practice Address - Phone:801-223-4860
Practice Address - Fax:801-371-8993
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT66883094405207LP2900X
UT66883098900207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine