Provider Demographics
NPI:1699062869
Name:OLSON, GUY ARTHUR (LPN)
Entity type:Individual
Prefix:MR
First Name:GUY
Middle Name:ARTHUR
Last Name:OLSON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 NE 223RD AVE UNIT 87
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-8772
Mailing Address - Country:US
Mailing Address - Phone:503-960-8553
Mailing Address - Fax:
Practice Address - Street 1:3201 NE 223RD AVE UNIT 87
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OR
Practice Address - Zip Code:97024-8772
Practice Address - Country:US
Practice Address - Phone:503-960-8553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200230090LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR200230090LPNOtherOREGON NURSING BOARD