Provider Demographics
NPI:1386321677
Name:OLSON, LISA MARIE (DNP, FNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:OLSON
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2509
Mailing Address - Country:US
Mailing Address - Phone:360-353-5511
Mailing Address - Fax:360-353-5502
Practice Address - Street 1:300 OAK ST STE B
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-2304
Practice Address - Country:US
Practice Address - Phone:360-353-5511
Practice Address - Fax:360-353-5502
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61542793363LF0000X
MN10394207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily