Provider Demographics
NPI:1134151459
Name:OLMSTED, JEANNE (MD)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:
Last Name:OLMSTED
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 1:1213 24TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2592
Mailing Address - Country:US
Mailing Address - Phone:360-376-2561
Mailing Address - Fax:
Practice Address - Street 1:1213 24TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2592
Practice Address - Country:US
Practice Address - Phone:360-293-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027090208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1070887Medicaid
WA1070887Medicaid