Provider Demographics
NPI:1356741623
Name:OLSON, LESLIE (BSN, RN)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 BEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5711
Mailing Address - Country:US
Mailing Address - Phone:806-787-4227
Mailing Address - Fax:
Practice Address - Street 1:2208 BEDFORD DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5711
Practice Address - Country:US
Practice Address - Phone:806-787-4227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-24
Last Update Date:2014-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX753322163W00000X
WA60241967163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse