Provider Demographics
NPI:1245045350
Name:OLESON, GUNNAR WAYNE
Entity type:Individual
Prefix:
First Name:GUNNAR
Middle Name:WAYNE
Last Name:OLESON
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 1:1144 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:POTTER
Mailing Address - State:NE
Mailing Address - Zip Code:69156-1047
Mailing Address - Country:US
Mailing Address - Phone:308-250-0980
Mailing Address - Fax:
Practice Address - Street 1:427 ILLINOIS ST, SIDNEY NE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162
Practice Address - Country:US
Practice Address - Phone:308-254-6270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant