Doctor Name: | JEREMI THOMAS OLSON |
NPI Number: | 1003803339 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 1489-023 |
Business Practice Address: | 700 S Park St Dean St. Mary's Outpatient Center Madison, WI - 537151830 |
Business Phone Number: | 6082602900 |
Business Fax Number: | 6082607975 |
Mailing Address: | 700 S Park St, Dean St. Mary's Outpatient Center MADISON |
State: | WI |
Postal Code: | 537151830 |
Phone Number: | 6082602900 |
Fax Number: | 6082607975 |
NPI Enumeration Date: | 10/03/2005 |
NPI Last Update Date: | 04/15/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 1489-023 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |