Healthcare Provider Details

I. General information

NPI: 1477500072
Provider Name (Legal Business Name): CAROL LY NN OLNICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 NORTHWEST BLVD
NASHUA NH
03063-4068
US

IV. Provider business mailing address

29 NORTHWEST BLVD
NASHUA NH
03063-4068
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-2273
  • Fax: 603-579-5191
Mailing address:
  • Phone: 603-577-2273
  • Fax: 603-579-5191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9337
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: