Provider Demographics
NPI:1578152195
Name:OLSON, BRENDA LEE (RN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:OLSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 GREEN POND RD
Mailing Address - Street 2:
Mailing Address - City:MILLERS FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01349-1204
Mailing Address - Country:US
Mailing Address - Phone:413-522-9180
Mailing Address - Fax:
Practice Address - Street 1:46 GREEN POND RD
Practice Address - Street 2:
Practice Address - City:MILLERS FALLS
Practice Address - State:MA
Practice Address - Zip Code:01349-1204
Practice Address - Country:US
Practice Address - Phone:413-522-9180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN166215163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care