Healthcare Provider Details

I. General information

NPI: 1023091311
Provider Name (Legal Business Name): ANN B OLSEN L.M., C.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 CHINOOK AVE
ENUMCLAW WA
98022-3747
US

IV. Provider business mailing address

247 CHINOOK AVE
ENUMCLAW WA
98022-3747
US

V. Phone/Fax

Practice location:
  • Phone: 360-825-5720
  • Fax: 306-802-9377
Mailing address:
  • Phone: 360-825-5720
  • Fax: 306-802-9377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW00000279
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7119597
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: