Provider Demographics
NPI:1871319806
Name:TRI-CITIES DIABETES PLLC
Entity type:Organization
Organization Name:TRI-CITIES DIABETES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSSON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-946-6124
Mailing Address - Street 1:1305 MANSFIELD ST STE 4
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3588
Mailing Address - Country:US
Mailing Address - Phone:509-946-6124
Mailing Address - Fax:
Practice Address - Street 1:1305 MANSFIELD ST STE 4
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3588
Practice Address - Country:US
Practice Address - Phone:509-946-6124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty