Provider Demographics
NPI:1649735226
Name:OLSON-HAMMINGA, MORGAN KELSEY (PA-C)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:KELSEY
Last Name:OLSON-HAMMINGA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:KELSEY
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:14734 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1927
Mailing Address - Country:US
Mailing Address - Phone:231-547-6554
Mailing Address - Fax:231-392-7332
Practice Address - Street 1:14734 PARK AVE
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1927
Practice Address - Country:US
Practice Address - Phone:231-547-6554
Practice Address - Fax:231-392-7332
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008961363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical