Provider Demographics
NPI:1659380954
Name:OLSON, JENNIFER JUNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JUNE
Last Name:OLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6401 UNIVERSITY AVE NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4341
Mailing Address - Country:US
Mailing Address - Phone:763-572-5710
Mailing Address - Fax:763-571-3008
Practice Address - Street 1:10961 CLUB WEST PKWY
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4671
Practice Address - Country:US
Practice Address - Phone:763-572-5710
Practice Address - Fax:763-528-2945
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN42020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1203511OtherMEDICA
MN127222OtherUCARE MN
MN1045886OtherPREFERRED ONE
MN269P3OLOtherBCBS OF MN
MN24227OtherAMERICA'S PPO
MNHP29302OtherHEALTHPARTNERS
MND25517Medicare UPIN