Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 30291 | MN |
Y | 207R00000X | Internist | 30291 | MN |
Y | 111NI0900X | Internist | 30291 | MN |
NPI | 1346227287 |
---|---|
Provider Name | Jennifer Olson |
First Address | Bloomington, MN 55425-4516 |
Second Address | St Louis Park, MN 55416-2527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 09/03/2021 |