Provider Demographics
NPI:1902272412
Name:OLSON, CAITRIN (PA-C)
Entity type:Individual
Prefix:
First Name:CAITRIN
Middle Name:
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 1:18 WARREN DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-3614
Mailing Address - Country:US
Mailing Address - Phone:570-441-8014
Mailing Address - Fax:
Practice Address - Street 1:11 OLD PARK LANE RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2507
Practice Address - Country:US
Practice Address - Phone:860-355-1149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3398363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical