Provider Demographics
NPI:1548599814
Name:OLSEN, SHAUNA (APRN)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 E 3900 S
Mailing Address - Street 2:SUITE C-230
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1214
Mailing Address - Country:US
Mailing Address - Phone:801-262-9494
Mailing Address - Fax:801-266-2074
Practice Address - Street 1:3838 S 700 E
Practice Address - Street 2:SUITE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1466
Practice Address - Country:US
Practice Address - Phone:801-269-0231
Practice Address - Fax:801-269-0304
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT4931822-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000067627Medicare PIN