Healthcare Provider Details

I. General information

NPI: 1114022233
Provider Name (Legal Business Name): MARIE J REEDY P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE J OLSON

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 BROADWAY
PLACERVILLE CA
95667-9001
US

IV. Provider business mailing address

1980 BROADWAY
PLACERVILLE CA
95667-9001
US

V. Phone/Fax

Practice location:
  • Phone: 530-622-3536
  • Fax: 530-622-3538
Mailing address:
  • Phone: 530-622-3536
  • Fax: 530-622-3538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1073128
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: