Healthcare Provider Details

I. General information

NPI: 1205135324
Provider Name (Legal Business Name): MAREN MICHELLE OLSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CARROLL ST PRMC STATION #379
SALISBURY MD
21801
US

IV. Provider business mailing address

100 E CARROLL ST
SALISBURY MD
21801-5422
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-7722
  • Fax:
Mailing address:
  • Phone: 410-543-7722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC04443
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: