Individual
KIRBY LEE OLMSTED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
15631 SW PEAVINE RD, MCMINNVILLE, OR 97128-8374
(503) 472-6582
(503) 472-6582
Mailing address
15631 SW PEAVINE RD, MCMINNVILLE, OR 97128-8374
(503) 472-6582
(503) 472-6582
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
081046618CRNA
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62-1766695
GROUP TAX ID
OR
Enumeration date
06/29/2007
Last updated
12/15/2010
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