Provider Demographics
NPI:1801262654
Name:AMY OLSON LLC
Entity type:Organization
Organization Name:AMY OLSON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:651-430-0018
Mailing Address - Street 1:333 MAIN ST N
Mailing Address - Street 2:SUITE 203
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5098
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 MAIN ST N
Practice Address - Street 2:SUITE 203
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5098
Practice Address - Country:US
Practice Address - Phone:651-430-0018
Practice Address - Fax:651-430-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty