Provider Demographics
NPI:1144704545
Name:OLSON, RYAN CHARLES (ND)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:CHARLES
Last Name:OLSON
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 RAGLE RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3142
Mailing Address - Country:US
Mailing Address - Phone:707-322-1688
Mailing Address - Fax:
Practice Address - Street 1:396 RAGLE RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3142
Practice Address - Country:US
Practice Address - Phone:707-322-1688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND980175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath