Provider Demographics
NPI:1720648637
Name:OLSON, LANA ROSE (LMT)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:ROSE
Last Name:OLSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4569 KUKUI ST APT 203
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1775
Mailing Address - Country:US
Mailing Address - Phone:808-664-6040
Mailing Address - Fax:
Practice Address - Street 1:4569 KUKUI ST APT 203
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1775
Practice Address - Country:US
Practice Address - Phone:808-664-6040
Practice Address - Fax:808-650-3601
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12742225700000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMAT-12742OtherHAWAII STATE MASSAGE BOARD