Provider Demographics
NPI:1831202035
Name:OLSEN, MARCI (PAC)
Entity type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MARCI
Other - Middle Name:
Other - Last Name:BRIGODE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 SW CARY PKWY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6224
Practice Address - Country:US
Practice Address - Phone:919-387-3176
Practice Address - Fax:919-387-3244
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052215363A00000X
NC0010-02267363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ62522Medicare UPIN
NC2076457Medicare PIN
PA060201Medicare ID - Type UnspecifiedGROUP ID #
PA097907QU6Medicare ID - Type Unspecified