Provider Demographics
NPI:1255369468
Name:OLSCAMP, STEPHANIE J (CNM)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:OLSCAMP
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:980 W. IRONWOOD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COEUR D'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-765-1455
Mailing Address - Fax:208-667-8655
Practice Address - Street 1:980 W. IRONWOOD
Practice Address - Street 2:SUITE 101
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-765-1455
Practice Address - Fax:208-667-8655
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-27717363L00000X
IDCNM50A367A00000X
IDNP571A176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806370600Medicaid
IDP71292Medicare UPIN
ID1343829Medicare ID - Type Unspecified