1609048560 NPI number — STACIE R OLSON ARNP

Table of content: STACIE R OLSON ARNP (NPI 1609048560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609048560 NPI number — STACIE R OLSON ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLSON
Provider First Name:
STACIE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609048560
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3800 SUMMITVIEW AVE
Provider Second Line Business Mailing Address:
MEMORIAL PHYSICIANS, PLLC
Provider Business Mailing Address City Name:
YAKIMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98902-2715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-248-7849
Provider Business Mailing Address Fax Number:
509-248-8291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 S. 72ND AVE, SUITE 102
Provider Second Line Business Practice Location Address:
HEALTHNOW WV
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-972-1259
Provider Business Practice Location Address Fax Number:
509-972-1258
Provider Enumeration Date:
03/31/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP60010945 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)