Provider Demographics
NPI:1104692540
Name:OLSEN, DEBORAH RENEE (LPN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:RENEE
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11406 E FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4687
Mailing Address - Country:US
Mailing Address - Phone:509-926-1031
Mailing Address - Fax:
Practice Address - Street 1:11406 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4687
Practice Address - Country:US
Practice Address - Phone:509-926-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00032122164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse