Provider Demographics
NPI:1538204706
Name:OLSON, PATRICIA (MED)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 12TH AVE N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 25TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2311
Practice Address - Country:US
Practice Address - Phone:701-451-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00154101YP2500X
ND327-8-1-95-93101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND58103-003AOther9400692
ND9400692OtherPHCS
SD6575850Medicaid
NC137157OtherTRIWEST
ND62-67338OtherMEDICA UBH
ND2327563OtherAMERICA'S PPO
ND990991045437OtherBHP PREFERRED 1
ND18051OtherBCBSND
NDHP52676OtherHEALTH PARTNERS
MN309S90LOtherBCBSMN