Basic Information
| Provider Information | |||||||||
| NPI: | 1285193540 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLSON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | CHRISTIAN LEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | WAKE FOREST SCHOOL OF MEDICINE MEDICAL CENTER BLVD. | ||||||||
| Address2: | DEPT. OF PSYCHIATRY | ||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271571087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367164551 | ||||||||
| FaxNumber: | 3367169642 | ||||||||
| Practice Location | |||||||||
| Address1: | WAKE FOREST SCHOOL OF MEDICINE MEDICAL CENTER BLVD. | ||||||||
| Address2: | DEPT. OF PSYCHIATRY | ||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271571087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367164551 | ||||||||
| FaxNumber: | 3367169642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2019 | ||||||||
| LastUpdateDate: | 03/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | NC | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.