Provider Demographics
NPI:1295092716
Name:OLSON, PAMELA B (FNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:B
Last Name:OLSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 BOSTIC LN
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:VA
Mailing Address - Zip Code:24136-3678
Mailing Address - Country:US
Mailing Address - Phone:540-921-4343
Mailing Address - Fax:
Practice Address - Street 1:133 BOSTIC LN
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:VA
Practice Address - Zip Code:24136-3678
Practice Address - Country:US
Practice Address - Phone:540-921-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024091571363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1295092716Medicaid
VA1295092716Medicaid
VAVV8145AMedicare PIN