Provider Demographics
NPI:1891463329
Name:OLSON, SANDRA FAYJEAN
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:FAYJEAN
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4456 PROSPECT HILL CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-3294
Mailing Address - Country:US
Mailing Address - Phone:208-585-8722
Mailing Address - Fax:
Practice Address - Street 1:4456 PROSPECT HILL CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-3294
Practice Address - Country:US
Practice Address - Phone:208-585-8722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care