Healthcare Provider Details

I. General information

NPI: 1023498557
Provider Name (Legal Business Name): DEBORAH KRISTIN OLSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE
LOS ANGELES CA
90095-3075
US

IV. Provider business mailing address

10833 LE CONTE AVE
LOS ANGELES CA
90095-3075
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-6244
  • Fax: 310-206-5843
Mailing address:
  • Phone: 310-825-6244
  • Fax: 310-206-5843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number621924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: