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General NPI Number Information
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NPI Number | 1902904345
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Entity Type | Individual
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Provider Name | LISA JANE OLSEN MD
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 02/07/2019
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Provider Practice Location Address
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Address Line | MADIGAN ARMY MEDICAL CENTER 9040 JACKSON
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City | TACOMA
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State | WA
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Zip | 98493-0003
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Country | US
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Telephone | 253-279-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 11302 91ST AVENUE CT SW
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City | LAKEWOOD
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State | WA
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Zip | 98498-3634
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Country | US
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Telephone | 253-302-4948
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 220410
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14297R
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5802
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License Number State | AK
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD60428736
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License Number State | WA
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