Provider Demographics
NPI:1407280852
Name:OLSON-MCMASTER, KIMBERLY A (MSOM, LAC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:OLSON-MCMASTER
Suffix:
Gender:F
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:MCMASTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSOM, L AC
Mailing Address - Street 1:753 N MAIN ST
Mailing Address - Street 2:SUITE F-5
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-3649
Mailing Address - Country:US
Mailing Address - Phone:480-703-5113
Mailing Address - Fax:
Practice Address - Street 1:753 N MAIN ST
Practice Address - Street 2:SUITE F-5
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3649
Practice Address - Country:US
Practice Address - Phone:480-703-5113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0816171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist