Individual provider Active NPI

Shannon Marie Olson, CNP

  • Adult Health Nurse Practitioner
  • Pine City, MN
National Provider Identifier
1710715214
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
11841 Issued in MN
Practice address
410 4TH Ave NE
Pine City, MN 55063-1200
Phone
(320) 310-5166
NPI assigned
Jul 25, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 11841 MN Primary

Addresses

Primary practice location

410 4TH Ave NE
Pine City, MN 55063-1200

Mailing address

410 4TH Ave NE
Pine City, MN 55063-1200
Phone (320) 310-5166

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241030001761 MN Practitioner - Nurse Practitioner 4880127729 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1200 6TH N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic CurrentSince Oct 1, 2024 Accepting new patients
Centracare Clinic Current Accepting new patients
Centracare Clinic CurrentSince Oct 1, 2024 Accepting new patients
Centracare Clinic Past Accepting new patients

Locations

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

Interoperability endpoints

  • Direct secure messaging: solson845226@direct.centracare.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1710715214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 4TH AVE NE",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "550631200",
            "telephone_number": "320-310-5166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 4TH AVE NE",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "550631200",
            "telephone_number": "320-310-5166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "SHANNON",
        "middle_name": "MARIE",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-25",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MN",
            "license": "11841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine City, MN

Sources for this page

Verify at the official NPI Registry.