Healthcare Provider Details

I. General information

NPI: 1689990954
Provider Name (Legal Business Name): KELLY OLMSTEAD LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 BROADWAY
SANTA CRUZ CA
95062-2511
US

IV. Provider business mailing address

1426 BROADWAY
SANTA CRUZ CA
95062-2511
US

V. Phone/Fax

Practice location:
  • Phone: 831-429-2229
  • Fax: 831-429-2228
Mailing address:
  • Phone: 831-429-2229
  • Fax: 831-429-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM260
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number10030018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: