Individual
MONIQUE OLSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5501 GRAVES RD, GALWAY, NY 12074-2303
(518) 242-6896
Mailing address
5501 GRAVES RD, GALWAY, NY 12074-2303
(518) 242-6896
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
384094536
NY
172A00000X
Driver
Primary
470300421
NY
Other
Enumeration date
10/29/2015
Last updated
10/29/2015
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