Provider Demographics
NPI:1558595785
Name:OLSON, BRADLEY ALLEN (IDMT, NREMT-P, RN)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ALLEN
Last Name:OLSON
Suffix:
Gender:M
Credentials:IDMT, NREMT-P, RN
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Other - Middle Name:
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Mailing Address - Street 1:58 RQS/DOSM 10212 SEYMOUR JOHNSON RD
Mailing Address - Street 2:BLDG 10202
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:89191
Mailing Address - Country:US
Mailing Address - Phone:702-653-3507
Mailing Address - Fax:
Practice Address - Street 1:25 BLACK WASH WAY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6324
Practice Address - Country:US
Practice Address - Phone:702-524-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians