Provider Demographics
NPI:1679772677
Name:OLSON, BECKY LYNN (RNC)
Entity type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:LYNN
Last Name:OLSON
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:MISS
Other - First Name:BECKY
Other - Middle Name:LYNN
Other - Last Name:HARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNC
Mailing Address - Street 1:1333 W 5TH ST, STE 110
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2752
Mailing Address - Country:US
Mailing Address - Phone:307-672-2522
Mailing Address - Fax:307-672-3732
Practice Address - Street 1:1333 W 5TH ST, STE 210
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2752
Practice Address - Country:US
Practice Address - Phone:307-672-2522
Practice Address - Fax:307-672-3732
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY13730.119363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY107189100Medicaid
WY20530Medicare PIN