Provider Demographics
NPI:1386813665
Name:OLSEN, SANDRA J (APN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:OLSEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 SIERRA ROSE DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2060
Mailing Address - Country:US
Mailing Address - Phone:775-352-9355
Mailing Address - Fax:775-352-3575
Practice Address - Street 1:645 SIERRA ROSE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2060
Practice Address - Country:US
Practice Address - Phone:775-352-9355
Practice Address - Fax:775-352-3575
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN27389207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV37710Medicare PIN
NVV37709Medicare PIN