Provider Demographics
NPI:1154887214
Name:OLSON, SHANNON (FNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:OLSON
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:GREAVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:600 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-1400
Mailing Address - Country:US
Mailing Address - Phone:612-486-3625
Mailing Address - Fax:
Practice Address - Street 1:600 1ST AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-1400
Practice Address - Country:US
Practice Address - Phone:612-486-3625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21994363LF0000X
MN6619363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily