Provider Demographics
NPI:1932198223
Name:OLSON, MAGGIE A (MLT)
Entity Type:Individual
Prefix:MRS
First Name:MAGGIE
Middle Name:A
Last Name:OLSON
Suffix:
Gender:F
Credentials:MLT
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:DOLAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:ST MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-0115
Mailing Address - Country:US
Mailing Address - Phone:208-686-1931
Mailing Address - Fax:
Practice Address - Street 1:1115 B ST
Practice Address - Street 2:
Practice Address - City:PLUMMER
Practice Address - State:ID
Practice Address - Zip Code:83857-0388
Practice Address - Country:US
Practice Address - Phone:208-686-1931
Practice Address - Fax:208-686-5133
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AMT 40988246RH0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RH0600XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyHistology