Provider Demographics
NPI:1336185776
Name:OLSON, JULIE A (PA-C, FNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:OLSON
Suffix:
Gender:F
Credentials:PA-C, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:MN
Mailing Address - Zip Code:56232-2333
Mailing Address - Country:US
Mailing Address - Phone:320-769-4323
Mailing Address - Fax:320-769-2972
Practice Address - Street 1:1282 WALNUT ST
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:MN
Practice Address - Zip Code:56232-2333
Practice Address - Country:US
Practice Address - Phone:320-769-4323
Practice Address - Fax:320-769-2972
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11253363A00000X
MN1805363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6820844Medicaid
SDS7964Medicare PIN
SD6820844Medicaid
SD500018725Medicare PIN