Provider Demographics
NPI:1508264656
Name:OLSON, MARTHA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8520 WILLIWA AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4249
Mailing Address - Country:US
Mailing Address - Phone:907-223-1225
Mailing Address - Fax:907-337-8607
Practice Address - Street 1:8520 WILLIWA AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4249
Practice Address - Country:US
Practice Address - Phone:907-223-1225
Practice Address - Fax:907-337-8607
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK9689163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant