Provider Demographics
NPI:1639274822
Name:OLSON, DEBORAH KAY (CPNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:OLSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6033 ELLIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-3153
Mailing Address - Country:US
Mailing Address - Phone:612-869-8820
Mailing Address - Fax:
Practice Address - Street 1:425 20TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-4400
Practice Address - Country:US
Practice Address - Phone:612-332-4973
Practice Address - Fax:612-371-0289
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20061275363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics