Provider Demographics
NPI:1750049177
Name:OLSON, JOHN PAUL CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:JOHN PAUL
Middle Name:CHRISTOPHER
Last Name:OLSON
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 1:204 SUMMIT CREST LN
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-4086
Mailing Address - Country:US
Mailing Address - Phone:405-589-8159
Mailing Address - Fax:
Practice Address - Street 1:204 SUMMIT CREST LN
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-4086
Practice Address - Country:US
Practice Address - Phone:405-589-8159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator