Provider Demographics
NPI:1235191776
Name:OLSON, DONNA J (PA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:OLSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 TREEMONT CIR
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-8718
Mailing Address - Country:US
Mailing Address - Phone:682-738-8079
Mailing Address - Fax:817-394-2278
Practice Address - Street 1:3901 TREEMONT CIR
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-8718
Practice Address - Country:US
Practice Address - Phone:682-738-8079
Practice Address - Fax:817-394-2278
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00025363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B5871Medicare ID - Type Unspecified
TX8F5882Medicare PIN
TXQ12346Medicare UPIN
TX8L18504Medicare PIN
TX8E0296Medicare ID - Type Unspecified