Provider Demographics
NPI:1174807978
Name:OLMSTEAD, DIANE M (LAC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:OLMSTEAD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N MAGUIRE AVE APT 272
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-9028
Mailing Address - Country:US
Mailing Address - Phone:520-982-1998
Mailing Address - Fax:
Practice Address - Street 1:5555 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2415
Practice Address - Country:US
Practice Address - Phone:520-982-1998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ699171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist