Healthcare Provider Details

I. General information

NPI: 1588706766
Provider Name (Legal Business Name): VALERIE OLNEY LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 WOODLAND SQUARE LOOP SE THE MARSTON CENTER #A19
LACEY WA
98503-1000
US

IV. Provider business mailing address

677 WOODLAND SQUARE LOOP SE THE MARSTON CENTER #A19
LACEY WA
98503-1000
US

V. Phone/Fax

Practice location:
  • Phone: 360-438-9600
  • Fax:
Mailing address:
  • Phone: 360-438-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00010091
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: