Provider Demographics
NPI:1356923031
Name:OLSON, NITA
Entity type:Individual
Prefix:MS
First Name:NITA
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:ND
Mailing Address - Zip Code:58735-3016
Mailing Address - Country:US
Mailing Address - Phone:701-818-2193
Mailing Address - Fax:
Practice Address - Street 1:300 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:ND
Practice Address - Zip Code:58735-3016
Practice Address - Country:US
Practice Address - Phone:701-818-2193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant