Provider Demographics
NPI:1407591712
Name:OLSON, NATHAN ALLEN JOSEPH (EMT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:ALLEN JOSEPH
Last Name:OLSON
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57032-2317
Mailing Address - Country:US
Mailing Address - Phone:605-212-5998
Mailing Address - Fax:
Practice Address - Street 1:1100 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:SD
Practice Address - Zip Code:57032-2317
Practice Address - Country:US
Practice Address - Phone:605-212-5998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDVFH0010583-12-2021343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)