Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW00000279 | WA |
NPI | 1023091311 |
---|---|
Provider Name | Ann B Olsen |
First Address | Enumclaw, WA 98022-3747 |
Second Address | Enumclaw, WA 98022-3747 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2005 |
Last Update Date | 10/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7119597 | (05) | WA |