Healthcare Provider Details

I. General information

NPI: 1790558641
Provider Name (Legal Business Name): JOSEPHINE LOUISE OLESON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10217 125TH STREET CT E
PUYALLUP WA
98374-2761
US

IV. Provider business mailing address

507 S 57TH ST
TACOMA WA
98408-6434
US

V. Phone/Fax

Practice location:
  • Phone: 253-864-4550
  • Fax:
Mailing address:
  • Phone: 206-945-0944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: