Individual
KEVIN R OLSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
175 WEST BROADWAY, LINCOLN, ME 04457-0000
(207) 794-6700
(207) 794-2572
Mailing address
PO BOX 99, LINCOLN, ME 04457-0099
(207) 794-6700
(207) 794-6777
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-254
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100273
ANTHEM
ME
01
—
201856
NGS
ME
05
—
330920099
—
ME
Enumeration date
03/23/2006
Last updated
04/05/2013
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