Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 35054558 | OH |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 35-054558 | OH |
NPI | 1184680910 |
---|---|
Provider Name | Cynthia G Olsen |
First Address | Dayton, OH 45435-0001 |
Second Address | Dayton, OH 45435-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 02/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0715579 | (05) | OH |
E32453 | (02) |