Provider Demographics
NPI:1518094259
Name:OLSON, DOROTHEA JUNE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHEA
Middle Name:JUNE
Last Name:OLSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-0415
Mailing Address - Country:US
Mailing Address - Phone:701-662-8273
Mailing Address - Fax:
Practice Address - Street 1:3883 74TH AVE. NE
Practice Address - Street 2:
Practice Address - City:FT. TOTTEN
Practice Address - State:ND
Practice Address - Zip Code:58335
Practice Address - Country:US
Practice Address - Phone:701-766-1600
Practice Address - Fax:701-766-1626
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR27823163W00000X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDR27823OtherREGISTERED NURSE