Provider Demographics
NPI:1649620147
Name:OLSON, BECCA
Entity type:Individual
Prefix:
First Name:BECCA
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20713 E OCOTILLO RD
Mailing Address - Street 2:UNIT 100
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6117
Mailing Address - Country:US
Mailing Address - Phone:480-882-9993
Mailing Address - Fax:
Practice Address - Street 1:20713 E OCOTILLO RD
Practice Address - Street 2:UNIT 100
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-6117
Practice Address - Country:US
Practice Address - Phone:480-882-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8560363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily