Provider Demographics
NPI:1699443424
Name:OLSON, SARA HAYNES (APRN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:HAYNES
Last Name:OLSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:HAYNES
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:113 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SHELL LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54871
Mailing Address - Country:US
Mailing Address - Phone:715-468-7833
Mailing Address - Fax:715-468-7839
Practice Address - Street 1:113 4TH AVE
Practice Address - Street 2:
Practice Address - City:SHELL LAKE
Practice Address - State:WI
Practice Address - Zip Code:54871
Practice Address - Country:US
Practice Address - Phone:715-468-7833
Practice Address - Fax:715-468-7839
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11965363LF0000X
MN8280363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine