Provider Demographics
NPI:1518361450
Name:OLSON, KRISTA (IBCLC)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1724
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-1724
Mailing Address - Country:US
Mailing Address - Phone:808-895-0782
Mailing Address - Fax:808-323-3393
Practice Address - Street 1:79-969 KEALAOLA ST
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-7907
Practice Address - Country:US
Practice Address - Phone:808-895-0782
Practice Address - Fax:808-323-3393
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIL-30235174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN