Provider Demographics
NPI:1962213926
Name:OLSON, CODY LEE
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:LEE
Last Name:OLSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 PADDOCK ST
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:NE
Mailing Address - Zip Code:69339-1147
Mailing Address - Country:US
Mailing Address - Phone:308-430-5505
Mailing Address - Fax:
Practice Address - Street 1:233 PADDOCK ST
Practice Address - Street 2:
Practice Address - City:CRAWFORD
Practice Address - State:NE
Practice Address - Zip Code:69339-1147
Practice Address - Country:US
Practice Address - Phone:308-430-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372500000X, 372600000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty