Provider Demographics
NPI:1194768465
Name:OLSON, SHARON L (DO)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:OLSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:64-5009 MANA RD
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-0486
Mailing Address - Country:US
Mailing Address - Phone:808-885-7880
Mailing Address - Fax:808-885-7809
Practice Address - Street 1:496 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4211
Practice Address - Country:US
Practice Address - Phone:707-695-7438
Practice Address - Fax:707-545-6068
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5483204D00000X
HIDOS578204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIHI00496OtherNORIDIAN
CA020A54830Medicare PIN
D97601Medicare UPIN