Healthcare Provider Details

I. General information

NPI: 1902558927
Provider Name (Legal Business Name): MOLLY MAE OLHEISER CHW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 SE COMBS FLAT RD
PRINEVILLE OR
97754-2562
US

IV. Provider business mailing address

384 SE COMBS FLAT RD
PRINEVILLE OR
97754-2562
US

V. Phone/Fax

Practice location:
  • Phone: 541-447-8439
  • Fax: 541-447-8724
Mailing address:
  • Phone: 541-447-8439
  • Fax: 541-447-8724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number105950
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: