Provider Demographics
NPI:1083864136
Name:BAZAN-OLSON, SANDRA PAULA (NP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:PAULA
Last Name:BAZAN-OLSON
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:701 WEST WETMORE RD. RM. 168
Mailing Address - Street 2:PIMACO AMPHITHEATERSCHOOLS DBA AMPHITHEATER PUB SCHOOLS
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1547
Mailing Address - Country:US
Mailing Address - Phone:520-696-5237
Mailing Address - Fax:520-696-5067
Practice Address - Street 1:701 WEST WETMORE RD. RM. 168
Practice Address - Street 2:AMPHITHEATER PUBLIC SCHOOLS
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1547
Practice Address - Country:US
Practice Address - Phone:520-696-5237
Practice Address - Fax:520-696-5067
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2024-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ303932363LP2300X
AZRN128955163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WS0200XNursing Service ProvidersRegistered NurseSchool