Provider Demographics
NPI:1295104040
Name:OLSON, AMELYN NAVARRO (DRPH, BSN, RN, CHES)
Entity type:Individual
Prefix:DR
First Name:AMELYN
Middle Name:NAVARRO
Last Name:OLSON
Suffix:
Gender:F
Credentials:DRPH, BSN, RN, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 BULL STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-545-4283
Mailing Address - Fax:
Practice Address - Street 1:129 BERRY DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-3093
Practice Address - Country:US
Practice Address - Phone:864-556-5799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC109808163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse