Provider Demographics
NPI:1275782500
Name:OLSEN, NATHAN (ND)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:OLSEN
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N DIVISION ST STE 200
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2009
Mailing Address - Country:US
Mailing Address - Phone:231-946-8600
Mailing Address - Fax:231-946-8650
Practice Address - Street 1:315 N DIVISION ST STE 200
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2009
Practice Address - Country:US
Practice Address - Phone:231-946-8600
Practice Address - Fax:231-946-8650
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1347175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath