Healthcare Provider Details

I. General information

NPI: 1659604270
Provider Name (Legal Business Name): LORI J OLAF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N K ST
TACOMA WA
98403-1623
US

IV. Provider business mailing address

PO BOX 236
HANSVILLE WA
98340-0236
US

V. Phone/Fax

Practice location:
  • Phone: 253-572-4115
  • Fax: 253-572-7446
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT00000822
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: