Individual
LOLA LOUISE AMDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1600 CONGRESS ST STE B, PORTLAND, ME 04102-2148
(207) 774-5222
Mailing address
557 OCEAN ST, SOUTH PORTLAND, ME 04106-6625
(603) 252-0556
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
055-0031471
VT
363A00000X
Physician Assistant
Primary
PA2334
ME
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/03/2019
Last updated
09/12/2022
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