Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | DE00011163 | WA |
Y | 1223E0200X | Endodontist | DEN00011163 | WA |
NPI | 1053351791 |
---|---|
Provider Name | Dr. Tina M. Olsson |
First Address | Fircrest, WA 98466 |
Second Address | Fircrest, WA 98466 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 12/06/2019 |