Provider Demographics
NPI:1023091311
Name:OLSEN, ANN B (LM, CPM)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:B
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 CHINOOK AVE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-3747
Mailing Address - Country:US
Mailing Address - Phone:360-825-5720
Mailing Address - Fax:306-802-9377
Practice Address - Street 1:247 CHINOOK AVE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3747
Practice Address - Country:US
Practice Address - Phone:360-825-5720
Practice Address - Fax:306-802-9377
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW00000279176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7119597Medicaid