Provider Demographics
NPI:1528094943
Name:OLSON-FITZGERALD, HEIDI M (PAC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:M
Last Name:OLSON-FITZGERALD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3363
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0363
Mailing Address - Country:US
Mailing Address - Phone:701-356-5503
Mailing Address - Fax:701-364-9781
Practice Address - Street 1:5257 27TH ST S STE 201
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7782
Practice Address - Country:US
Practice Address - Phone:701-356-5503
Practice Address - Fax:701-364-9781
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0178363A00000X
MN9250363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND0118265OtherMEDICA #
ND24553OtherNDBS #
MN838S6OLOtherMNBS #
NDHP25814OtherHEALTHPARTNERS #
NDDA9011015571OtherPREFERRED ONE #
ND0118267OtherMEDICA #
ND07Q72OLOtherMNBS #
MN1528094943Medicaid
ND45G88OLOtherMNBS #
ND73A60OLOtherMNBS #
ND752287800Medicaid
ND0118270OtherMEDICA #
ND975263OtherAMERICA'S PPO/ARAZ #
ND137064OtherUCARE #
MN1528094943Medicaid
MN970005419Medicare PIN
NDHP25814OtherHEALTHPARTNERS #
ND200028334Medicare ID - Type UnspecifiedRR MEDICARE #
ND752287800Medicaid
NDDA9011015571OtherPREFERRED ONE #
ND975263OtherAMERICA'S PPO/ARAZ #
ND970001994Medicare ID - Type UnspecifiedMN MEDICARE #