Provider Demographics
NPI:1295738789
Name:OLSON, SUSAN KAY (CNP/PAC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KAY
Last Name:OLSON
Suffix:
Gender:F
Credentials:CNP/PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1411
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-1411
Mailing Address - Country:US
Mailing Address - Phone:605-352-8767
Mailing Address - Fax:605-352-8784
Practice Address - Street 1:455 KANSAS AVE SE
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2522
Practice Address - Country:US
Practice Address - Phone:605-352-8767
Practice Address - Fax:605-352-8784
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000049363L00000X
SD0625363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6821605Medicaid
SDP00331087OtherRAILROAD MEDICARE
SD4994028OtherWELLMARK
SD9237905OtherDAKOTACARE
SDP00331087OtherRAILROAD MEDICARE
SD9237905OtherDAKOTACARE