Healthcare Provider Details

I. General information

NPI: 1891137931
Provider Name (Legal Business Name): STEVEN OLSEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 EASTLAND AVE SE
WARREN OH
44484-4503
US

IV. Provider business mailing address

667 EASTLAND AVE SE
WARREN OH
44484-4503
US

V. Phone/Fax

Practice location:
  • Phone: 330-841-4177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number58.004874
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: