Provider Demographics
NPI:1902807852
Name:OLSEN, DAWN MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:MARIE
Last Name:OLSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7165 E UNIVERSITY DR STE 187
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-6415
Mailing Address - Country:US
Mailing Address - Phone:480-668-5000
Mailing Address - Fax:480-428-8593
Practice Address - Street 1:3600 N 3RD AVE STE B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3944
Practice Address - Country:US
Practice Address - Phone:480-668-5000
Practice Address - Fax:480-668-5065
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ0073932086S0129X
AZ2292363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ284618Medicaid
AZWCSKQOtherSUN HEALTH GROUP # AHI
AZS84481Medicare UPIN
AZ499956Medicaid
AZP00253494OtherRAILROAD MEDICARE