Provider Demographics
NPI:1316516073
Name:OLSSON, GLORIA
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:OLSSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 DUPORTAIL ST # 111
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-6103
Mailing Address - Country:US
Mailing Address - Phone:509-946-6124
Mailing Address - Fax:866-692-4493
Practice Address - Street 1:1305 MANSFIELD ST STE 4
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3588
Practice Address - Country:US
Practice Address - Phone:509-946-6124
Practice Address - Fax:866-692-4493
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61162401363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily