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General NPI Number Information
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NPI Number | 1538788849
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Entity Type | Individual
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Provider Name | ALLYCE MARY OLMSTEAD
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Gender | Female
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 04/16/2020
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Provider Practice Location Address
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Address Line | 601 JOHN ST STE M-020
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City | KALAMAZOO
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State | MI
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Zip | 49007-5381
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Country | US
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Telephone | 269-341-8282
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Fax | 269-341-8610
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Provider Business Mailing Address
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Address Line | 1492 102ND AVE
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City | PLAINWELL
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State | MI
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Zip | 49080-9703
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Country | US
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Telephone | 260-303-2418
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP2201X
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Taxonomy Name | Ambulatory Care Registered Nurse
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License Number | 4704304305
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License Number State | MI
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