Provider Demographics
NPI:1669904280
Name:OLSON, ROSA (CST-CSFA)
Entity type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:CST-CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 CALDERA BLVD APT 287
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-2894
Mailing Address - Country:US
Mailing Address - Phone:432-262-1900
Mailing Address - Fax:
Practice Address - Street 1:3609 CALDERA BLVD APT 287
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-2894
Practice Address - Country:US
Practice Address - Phone:432-262-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-02
Last Update Date:2017-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant