Provider Demographics
NPI:1316508229
Name:OLSON, MELVA ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:MELVA
Middle Name:ANN
Last Name:OLSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MELVA
Other - Middle Name:ANN
Other - Last Name:STORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:159 SPRINGER RD
Mailing Address - Street 2:
Mailing Address - City:WEST SAND LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12196-2031
Mailing Address - Country:US
Mailing Address - Phone:518-694-1828
Mailing Address - Fax:
Practice Address - Street 1:87 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-2613
Practice Address - Country:US
Practice Address - Phone:518-449-1142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-23
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306125A163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health