Provider Demographics
NPI:1770285942
Name:OLSON, BERYL ELISABETH
Entity type:Individual
Prefix:
First Name:BERYL
Middle Name:ELISABETH
Last Name:OLSON
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 1:3081 VISTA VERDE LN SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-1449
Mailing Address - Country:US
Mailing Address - Phone:408-655-4745
Mailing Address - Fax:
Practice Address - Street 1:3081 VISTA VERDE LN SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-1449
Practice Address - Country:US
Practice Address - Phone:408-655-4745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program