Provider Demographics
NPI:1699661421
Name:OLSON, KEISHA RENAE
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:RENAE
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KEISHA
Other - Middle Name:RENAE
Other - Last Name:BICE-BAUMGARTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:506 SOUTH ST NE
Mailing Address - Street 2:
Mailing Address - City:CRARY
Mailing Address - State:ND
Mailing Address - Zip Code:58327-2704
Mailing Address - Country:US
Mailing Address - Phone:701-381-6567
Mailing Address - Fax:
Practice Address - Street 1:506 SOUTH ST NE
Practice Address - Street 2:
Practice Address - City:CRARY
Practice Address - State:ND
Practice Address - Zip Code:58327-2704
Practice Address - Country:US
Practice Address - Phone:701-381-6567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion