Provider Demographics
NPI:1740274083
Name:OLSON, DEANNA K (MD)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:K
Last Name:OLSON
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 1:3250 SE LLEWELLYN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6544
Mailing Address - Country:US
Mailing Address - Phone:503-353-0888
Mailing Address - Fax:503-653-5060
Practice Address - Street 1:3250 SE LLEWELLYN ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6544
Practice Address - Country:US
Practice Address - Phone:503-353-0888
Practice Address - Fax:503-653-5060
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17140208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR028519Medicaid
E93690Medicare UPIN
OR028519Medicaid