Provider Demographics
NPI:1093740037
Name:OLSSON, PAMELA N (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:N
Last Name:OLSSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:NICHOLSON
Other - Last Name:BROUSSARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:59 WINDSOR CT.
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-1733
Mailing Address - Country:US
Mailing Address - Phone:603-313-9943
Mailing Address - Fax:603-924-3569
Practice Address - Street 1:7 PROSPECT ST.
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-4490
Practice Address - Country:US
Practice Address - Phone:603-889-6147
Practice Address - Fax:603-883-1568
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH93512084P0800X
TXJ14732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE3522Medicare ID - Type Unspecified