Provider Demographics
NPI:1528361995
Name:OLSON, HEATHER RENEE (PA)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:RENEE
Last Name:OLSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6098 FM 311
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-7253
Mailing Address - Country:US
Mailing Address - Phone:830-885-5541
Mailing Address - Fax:830-885-5542
Practice Address - Street 1:6098 FM 311
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-7253
Practice Address - Country:US
Practice Address - Phone:830-885-5541
Practice Address - Fax:830-885-5542
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical