Provider Demographics
NPI:1801155114
Name:OLSEN, HALEH (CN)
Entity type:Individual
Prefix:
First Name:HALEH
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:HALEH
Other - Middle Name:
Other - Last Name:ETEMADINEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2872
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-2872
Mailing Address - Country:US
Mailing Address - Phone:425-442-5209
Mailing Address - Fax:
Practice Address - Street 1:634 7TH AVE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5665
Practice Address - Country:US
Practice Address - Phone:425-442-5209
Practice Address - Fax:425-650-1695
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU60243402133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist