Provider Demographics
NPI:1720092430
Name:OLSON, SHARON L (PHD APRN)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:L
Last Name:OLSON
Suffix:
Gender:F
Credentials:PHD APRN
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 55
Mailing Address - Street 2:
Mailing Address - City:OLD MISSION
Mailing Address - State:MI
Mailing Address - Zip Code:49673-0055
Mailing Address - Country:US
Mailing Address - Phone:231-223-9299
Mailing Address - Fax:
Practice Address - Street 1:615 E 8TH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2630
Practice Address - Country:US
Practice Address - Phone:231-929-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISO153255363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M94810Medicare ID - Type Unspecified