1174039697 NPI number — MS. MELISSA YVETTE OLSON TEACHER'S LICENCE

Table of content: MS. MELISSA YVETTE OLSON TEACHER'S LICENCE (NPI 1174039697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174039697 NPI number — MS. MELISSA YVETTE OLSON TEACHER'S LICENCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLSON
Provider First Name:
MELISSA
Provider Middle Name:
YVETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
TEACHER'S LICENCE
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:
1174039697
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6101 SEQUOIA RD NW APT A25
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87120-3415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-550-1016
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6101 SEQUOIA RD NW
Provider Second Line Business Practice Location Address:
APT A25
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87120-8712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-550-1016
Provider Business Practice Location Address Fax Number:
505-550-1016
Provider Enumeration Date:
12/20/2017

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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