Provider Demographics
NPI:1952645962
Name:OLSEN, MARYNA (RN, BSN)
Entity Type:Individual
Prefix:
First Name:MARYNA
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 W MOORHEAD CIR
Mailing Address - Street 2:#A
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6139
Mailing Address - Country:US
Mailing Address - Phone:303-763-0661
Mailing Address - Fax:
Practice Address - Street 1:999 W MOORHEAD CIR
Practice Address - Street 2:#A
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-6139
Practice Address - Country:US
Practice Address - Phone:303-763-0661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO192031163W00000X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical