Provider Demographics
NPI:1952355836
Name:OLSON, KATHLEEN LUCILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:LUCILLE
Last Name:OLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 BRISTOL WAY
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-7289
Mailing Address - Country:US
Mailing Address - Phone:919-774-9843
Mailing Address - Fax:
Practice Address - Street 1:2817 REILLY RD
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7324
Practice Address - Country:US
Practice Address - Phone:910-907-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42998208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics