Individual
AMANDA S OLSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2200 DICKINSON RD UNIT 17B, DE PERE, WI 54115-4070
(920) 965-1234
(920) 965-1232
Mailing address
2200 DICKINSON RD UNIT 17B, DE PERE, WI 54115-4070
(920) 965-1234
(920) 965-1232
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3281-23
WI
363A00000X
Physician Assistant
PA4138
MA
363AM0700X
Medical Physician Assistant
3281-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100037410
—
WI
01
—
3281-23
WISCONSIN PA LICENSE
WI
01
—
PA4138
LICENSE NUMBER
MA
Enumeration date
03/02/2011
Last updated
04/10/2023
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