Provider Demographics
NPI:1124756234
Name:OLSEN, TESSA LAUREL
Entity type:Individual
Prefix:MRS
First Name:TESSA
Middle Name:LAUREL
Last Name:OLSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 S LARKSPUR TRL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-3328
Mailing Address - Country:US
Mailing Address - Phone:605-731-9638
Mailing Address - Fax:
Practice Address - Street 1:1303 N LACROSSE ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6956
Practice Address - Country:US
Practice Address - Phone:605-755-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant