Provider Demographics
NPI:1871025262
Name:OLSEN, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:OLSEN
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 1:4201 TUDOR CENTRE DR
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5914
Mailing Address - Country:US
Mailing Address - Phone:907-729-4320
Mailing Address - Fax:907-729-4102
Practice Address - Street 1:4201 TUDOR CENTRE DR
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5914
Practice Address - Country:US
Practice Address - Phone:907-729-4320
Practice Address - Fax:907-729-4102
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK110925225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist