Provider Demographics
NPI:1659378909
Name:OLSON, JENNIFER JEAN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:OLSON
Suffix:
Gender:F
Credentials:MD
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1965 S US 29 HWY
Practice Address - Street 2:
Practice Address - City:CHINA GROVE
Practice Address - State:NC
Practice Address - Zip Code:28023-5684
Practice Address - Country:US
Practice Address - Phone:704-855-8338
Practice Address - Fax:704-855-8339
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2007775AOtherMEDICARE INDIVIDUAL ID
NC8913136Medicaid
NC2007775Medicare ID - Type Unspecified
NC2007775AOtherMEDICARE INDIVIDUAL ID
NC2327875GMedicare PIN