Provider Demographics
NPI:1154337350
Name:OLSEN, AMY H (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:H
Last Name:OLSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 PROVIDENCE POINT DR SE STE C
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-6216
Mailing Address - Country:US
Mailing Address - Phone:425-414-3939
Mailing Address - Fax:425-738-3110
Practice Address - Street 1:3707 PROVIDENCE POINT DR SE STE C
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6216
Practice Address - Country:US
Practice Address - Phone:425-414-3939
Practice Address - Fax:425-738-3110
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8398133Medicaid
WAG8866683Medicare PIN
WA8398133Medicaid