Healthcare Provider Details

I. General information

NPI: 1578652012
Provider Name (Legal Business Name): TOM OLMSTED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7825 N SOUND DR
SEDRO WOOLLEY WA
98284-7675
US

IV. Provider business mailing address

831 KEY ST
BELLINGHAM WA
98225-5627
US

V. Phone/Fax

Practice location:
  • Phone: 425-349-8555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN00093297
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: