Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 0101265507 | VA |
NPI | 1265708861 |
---|---|
Provider Name | Ms. Michelle Lynn Olson |
First Address | Richmond, VA 23291-1734 |
Second Address | Richmond, VA 23298-5051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2012 |
Last Update Date | 11/12/2018 |