Provider Demographics
NPI:1932799525
Name:OLSON, MOLLY M (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:M
Last Name:OLSON
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:SCHELLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1803 16TH ST S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5804
Mailing Address - Country:US
Mailing Address - Phone:218-252-2134
Mailing Address - Fax:
Practice Address - Street 1:4671 38TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7866
Practice Address - Country:US
Practice Address - Phone:701-404-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR43825363L00000X
MN8066363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner