Provider Demographics
NPI:1710691662
Name:OLSON, GRACE KATHERINE (ARNP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:KATHERINE
Last Name:OLSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7904 E GUNNING DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99212-1632
Mailing Address - Country:US
Mailing Address - Phone:509-954-5386
Mailing Address - Fax:
Practice Address - Street 1:400 E 5TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1334
Practice Address - Country:US
Practice Address - Phone:509-838-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61395576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily