Provider Demographics
NPI:1053758615
Name:OLSEN, D'ANNE (LMT)
Entity type:Individual
Prefix:
First Name:D'ANNE
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 HAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1765
Mailing Address - Country:US
Mailing Address - Phone:971-506-0498
Mailing Address - Fax:503-538-9773
Practice Address - Street 1:2501 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1965
Practice Address - Country:US
Practice Address - Phone:971-506-0498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13633174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist