Provider Demographics
NPI:1750691242
Name:OLSON, JOSEPHINE NGUYEN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:NGUYEN
Last Name:OLSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:JUNIOR
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 CALLOWAY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2513
Mailing Address - Country:US
Mailing Address - Phone:661-410-7546
Mailing Address - Fax:
Practice Address - Street 1:3400 CALLOWAY DR STE 200
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2513
Practice Address - Country:US
Practice Address - Phone:661-410-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21153363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant