1447525290 NPI number — TAMARA OLSON 101YA0400X

Table of content: TAMARA OLSON 101YA0400X (NPI 1447525290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447525290 NPI number — TAMARA OLSON 101YA0400X

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLSON
Provider First Name:
TAMARA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
101YA0400X
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:
1447525290
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3281 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPANISH FORK
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84660-8501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-851-7652
Provider Business Mailing Address Fax Number:
801-851-7649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 N FREEDOM BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVO
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84601-1677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-373-4760
Provider Business Practice Location Address Fax Number:
801-373-0639
Provider Enumeration Date:
03/13/2012

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 16950 . This is a "101YA0400X" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com