Healthcare Provider Details

I. General information

NPI: 1205898269
Provider Name (Legal Business Name): RONALD LEE OLSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 ARLINGTON AVE
LEMOORE CA
93245-9173
US

IV. Provider business mailing address

827 ARLINGTON AVE
LEMOORE CA
93245-9173
US

V. Phone/Fax

Practice location:
  • Phone: 301-325-6306
  • Fax:
Mailing address:
  • Phone: 301-325-6306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1746
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: