Healthcare Provider Details

I. General information

NPI: 1457399248
Provider Name (Legal Business Name): ELLEN T. OLSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 N CENTRAL AVE 1600
PHOENIX AZ
85004-4527
US

IV. Provider business mailing address

1850 N CENTRAL AVE 1600
PHOENIX AZ
85004-4527
US

V. Phone/Fax

Practice location:
  • Phone: 602-744-4765
  • Fax: 602-744-4799
Mailing address:
  • Phone: 602-744-4765
  • Fax: 602-744-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number40418
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00040224
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD00040224
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: