Provider Demographics
NPI:1285016501
Name:OLSON, DANA
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:DUNNINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:52 SAN PEDRO DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-9557
Mailing Address - Country:US
Mailing Address - Phone:509-899-2415
Mailing Address - Fax:
Practice Address - Street 1:52 SAN PEDRO DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-9557
Practice Address - Country:US
Practice Address - Phone:509-899-2415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician