Provider Demographics
NPI:1902558927
Name:OLHEISER, MOLLY MAE (CHW)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:MAE
Last Name:OLHEISER
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 SE COMBS FLAT RD
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-2562
Mailing Address - Country:US
Mailing Address - Phone:541-447-8439
Mailing Address - Fax:541-447-8724
Practice Address - Street 1:384 SE COMBS FLAT RD
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-2562
Practice Address - Country:US
Practice Address - Phone:541-447-8439
Practice Address - Fax:541-447-8724
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR105950172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker