Provider Demographics
NPI:1689272478
Name:OLSON, GWENNA CARIE (CRNA, RN)
Entity Type:Individual
Prefix:MRS
First Name:GWENNA
Middle Name:CARIE
Last Name:OLSON
Suffix:
Gender:F
Credentials:CRNA, RN
Other - Prefix:
Other - First Name:GWENNA
Other - Middle Name:LYNN
Other - Last Name:CARIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA, RN
Mailing Address - Street 1:62301 STATE HWY 14
Mailing Address - Street 2:
Mailing Address - City:UNDERWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98651-9038
Mailing Address - Country:US
Mailing Address - Phone:312-420-0433
Mailing Address - Fax:
Practice Address - Street 1:10 KRUGER ROAD
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:MT
Practice Address - Zip Code:59859
Practice Address - Country:US
Practice Address - Phone:406-826-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10608290-3102163WC0200X
MTNUR-APRN-LIC-173434367500000X
WA134653367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine