Individual
HEATHER OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1309 10TH AVE W, MOBRIDGE, SD 57601-1146
(605) 845-3692
(605) 845-8252
Mailing address
1309 10TH AVE W, MOBRIDGE, SD 57601-1146
(605) 845-3692
(605) 845-8252
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0904
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952723702
—
SD
01
—
S108186
PTAN
—
Enumeration date
01/14/2014
Last updated
11/18/2015
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