Provider Demographics
NPI:1992928790
Name:OLSON, KRISTINE ELAINE (CDM, CPM)
Entity type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:ELAINE
Last Name:OLSON
Suffix:
Gender:F
Credentials:CDM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 W 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-2009
Mailing Address - Country:US
Mailing Address - Phone:907-333-2229
Mailing Address - Fax:
Practice Address - Street 1:1340 W 70TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-2009
Practice Address - Country:US
Practice Address - Phone:907-333-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK41176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK41OtherSTATE LICENSE NUMBER
AKNM8947Medicaid