Provider Demographics
NPI:1477707123
Name:OLSON, TAWNY ALESE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TAWNY
Middle Name:ALESE
Last Name:OLSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:TAWNY
Other - Middle Name:ALESE
Other - Last Name:POLHAMUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNA-TMA
Mailing Address - Street 1:204 RENO AVE N.
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:MN
Mailing Address - Zip Code:56220
Mailing Address - Country:US
Mailing Address - Phone:507-223-5843
Mailing Address - Fax:
Practice Address - Street 1:106 NORTH 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1034
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL059880-0164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse