Provider Demographics
NPI:1811567696
Name:OLSON, MAREN LOUISE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:MAREN
Middle Name:LOUISE
Last Name:OLSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11045 T PLZ APT 308
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3563
Mailing Address - Country:US
Mailing Address - Phone:612-940-4446
Mailing Address - Fax:
Practice Address - Street 1:11045 T PLZ APT 308
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3563
Practice Address - Country:US
Practice Address - Phone:612-940-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2616363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant