Provider Demographics
NPI:1629070123
Name:OLSON, JOAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:E
Last Name:OLSON
Suffix:
Gender:F
Credentials:MD
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 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-233-7489
Practice Address - Street 1:4540 UNION BAY PL NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4025
Practice Address - Country:US
Practice Address - Phone:206-320-8050
Practice Address - Fax:206-320-8048
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00138764OtherRAILROAD MEDICARE
WAG679836Medicare UPIN
WAG8800976Medicare PIN