Provider Demographics
NPI:1386761690
Name:OLSON, CORY LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:LYNN
Last Name:OLSON
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1210 W 18TH ST STE 100
Mailing Address - Street 2:VAN DEMARK BUILDING
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-9890
Mailing Address - Country:US
Mailing Address - Phone:605-312-8500
Mailing Address - Fax:605-312-8501
Practice Address - Street 1:1210 W 18TH ST STE 100
Practice Address - Street 2:VAN DEMARK BUILDING
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-9890
Practice Address - Country:US
Practice Address - Phone:605-312-8500
Practice Address - Fax:605-312-8501
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2016-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SD0780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant