Individual
MRS. KIMBERLY CARRIE OLVING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
801 OSTRUM ST, BETHLEHEM, PA 18015-1000
(484) 526-4500
(484) 526-6674
Mailing address
PO BOX 783311, PHILADELPHIA, PA 19178-3311
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2011035892
MO
363AM0700X
Medical Physician Assistant
Primary
MA056730
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447412770
—
MO
05
—
1871865485
—
MO
01
—
26D0679044
CLIA
MO
Enumeration date
01/30/2012
Last updated
05/20/2019
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