Healthcare Provider Details

I. General information

NPI: 1750273033
Provider Name (Legal Business Name): SHAWNA T OLSEN LE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2025
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 WILLAMETTE ST
EUGENE OR
97401-4048
US

IV. Provider business mailing address

1590 WILLAMETTE ST
EUGENE OR
97401-4048
US

V. Phone/Fax

Practice location:
  • Phone: 547-357-7594
  • Fax: 503-343-6242
Mailing address:
  • Phone: 541-357-7594
  • Fax: 503-343-6242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberBAPE10249209
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: