Individual
AMANDA G. OLSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
300 W 27TH ST, LUMBERTON, NC 28358-3075
(910) 671-5032
Mailing address
300 W 27TH ST, LUMBERTON, NC 28358-3075
(910) 671-5032
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA.200488
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01825596
—
MS
05
—
2171305
—
LA
Enumeration date
11/22/2011
Last updated
11/15/2013
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