Provider Demographics
NPI:1245326651
Name:OLSON, LISA MARLENE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARLENE
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 1:330 S GARDEN WAY
Mailing Address - Street 2:STE 390
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8179
Mailing Address - Country:US
Mailing Address - Phone:541-683-1796
Mailing Address - Fax:
Practice Address - Street 1:330 S GARDEN WAY STE 390
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8179
Practice Address - Country:US
Practice Address - Phone:541-683-1796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01005363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant