Doctor Name: | KIMBERLY ANNE OLCHEWSKY |
NPI Number: | 1033530308 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | C05279 |
Business Practice Address: | 1411 Madison Park Dr Glen Burnie, MD - 210616185 |
Business Phone Number: | 4105536360 |
Business Fax Number: | |
Mailing Address: | 1411 Madison Park Dr, GLEN BURNIE |
State: | MD |
Postal Code: | 210616185 |
Phone Number: | 4105536360 |
Fax Number: | |
NPI Enumeration Date: | 01/03/2014 |
NPI Last Update Date: | 06/07/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | C05279 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |