MEDICARE: MRS. LYNN MARIE OLSON MSN, CNM, WHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	NMW1759	CA

General Provider Information

NPI Number	:	1568681971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYNN MARIE OLSON MSN, CNM, WHNP

Provider Business Mailing Address
First Line	:	5616 LAKE LINDERO DR
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-1907
Country	:	US
Telephone Number	:	818-597-9142
Fax Number	:	805-987-9197

Provider Business Practice Location Address
First Line	:	3901 LAS POSAS RD STE 207
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-1506
Country	:	US
Telephone Number	:	805-987-6807
Fax Number	:	805-987-9197

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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