Provider Demographics
NPI:1972608883
Name:OLSON, CAROL ROBERTSON (CNS RXN)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ROBERTSON
Last Name:OLSON
Suffix:
Gender:F
Credentials:CNS RXN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11444 W PROGRESS PL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-1681
Mailing Address - Country:US
Mailing Address - Phone:303-467-4030
Mailing Address - Fax:303-467-4064
Practice Address - Street 1:3400 LUTHERAN PKWY
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6035
Practice Address - Country:US
Practice Address - Phone:303-467-4030
Practice Address - Fax:303-467-4064
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO61243363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99850338Medicaid
COC473438Medicare PIN
COP71350Medicare UPIN