Provider Demographics
NPI:1437186897
Name:OLSON, JUDITH OYAMA (FNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:OYAMA
Last Name:OLSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 UHRMANN RD STE B
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1174
Mailing Address - Country:US
Mailing Address - Phone:541-882-8823
Mailing Address - Fax:
Practice Address - Street 1:2680 UHRMANN RD STE B
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1174
Practice Address - Country:US
Practice Address - Phone:541-882-8823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR091000232N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR072533Medicaid
ORR97407Medicare UPIN
OR072533Medicaid