Provider Demographics
NPI:1598170722
Name:OLANNA, ELSIE MAUDE
Entity Type:Individual
Prefix:MS
First Name:ELSIE
Middle Name:MAUDE
Last Name:OLANNA
Suffix:
Gender:F
Credentials:
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 113
Mailing Address - Street 2:# 1 TUTU ST.
Mailing Address - City:BREVIG
Mailing Address - State:AK
Mailing Address - Zip Code:99785
Mailing Address - Country:US
Mailing Address - Phone:907-643-1511
Mailing Address - Fax:907-642-2254
Practice Address - Street 1:1 TUTU ST.
Practice Address - Street 2:
Practice Address - City:BREVIG
Practice Address - State:AK
Practice Address - Zip Code:99785
Practice Address - Country:US
Practice Address - Phone:907-643-1511
Practice Address - Fax:907-642-2254
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)