Healthcare Provider Details

I. General information

NPI: 1174898795
Provider Name (Legal Business Name): CAROLINE MAROTEN OLNEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 S MACADAM AVE STE 200
PORTLAND OR
97239-3827
US

IV. Provider business mailing address

1301 DELAWARE ST
BERKELEY CA
94702-1408
US

V. Phone/Fax

Practice location:
  • Phone: 415-596-3567
  • Fax:
Mailing address:
  • Phone: 415-596-3567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number17475
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number201901141NP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number641291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: