Provider Demographics
NPI:1730134487
Name:OLEK, OSCAR LAVERN
Entity Type:Individual
Prefix:MR
First Name:OSCAR
Middle Name:LAVERN
Last Name:OLEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 COUNTY ROAD 132
Mailing Address - Street 2:
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-8714
Mailing Address - Country:US
Mailing Address - Phone:218-286-3289
Mailing Address - Fax:
Practice Address - Street 1:27040 COUNTY ROAD 9
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5456
Practice Address - Country:US
Practice Address - Phone:218-751-6405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0693815163W00000X
MNR069381-5367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse