Provider Demographics
NPI:1700492634
Name:OLSON, LISA ANNE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
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 1:8515 PARKVILLA DR APT 201E
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN IRON
Mailing Address - State:MN
Mailing Address - Zip Code:55768-9602
Mailing Address - Country:US
Mailing Address - Phone:218-969-3724
Mailing Address - Fax:
Practice Address - Street 1:1309 E 40TH ST
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-3609
Practice Address - Country:US
Practice Address - Phone:218-262-6675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1741614163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse