Healthcare Provider Details

I. General information

NPI: 1134151459
Provider Name (Legal Business Name): JEANNE OLMSTED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 24TH ST SUITE 100
ANACORTES WA
98221-2592
US

IV. Provider business mailing address

1213 24TH ST SUITE 100
ANACORTES WA
98221-2592
US

V. Phone/Fax

Practice location:
  • Phone: 360-293-4655
  • Fax:
Mailing address:
  • Phone: 360-376-2561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00027090
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: