Provider Demographics
NPI:1063443679
Name:OLSON-GEIER, KATE-LYNN M (PA)
Entity Type:Individual
Prefix:
First Name:KATE-LYNN
Middle Name:M
Last Name:OLSON-GEIER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 S KINSMAN RD
Mailing Address - Street 2:SLOT 303125
Mailing Address - City:SENECA
Mailing Address - State:IL
Mailing Address - Zip Code:61360-9317
Mailing Address - Country:US
Mailing Address - Phone:815-955-4174
Mailing Address - Fax:
Practice Address - Street 1:150 W HIGH ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1463
Practice Address - Country:US
Practice Address - Phone:815-942-2932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001901363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL970029506OtherRAILROAD MEDICARE
ILP75102Medicare UPIN
IL203705Medicare ID - Type Unspecified