| Doctor Name: | MRS. PRUDENCE MELINDA OLSEN |
| NPI Number: | 1619228145 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 271 |
| Business Practice Address: | 1120 Glenns Bay Rd Surfside Beach, SC - 295754757 |
| Business Phone Number: | 8432155492 |
| Business Fax Number: | 8432155512 |
| Mailing Address: | 1552 Heathmuir Dr, MYRTLE BEACH |
| State: | SC |
| Postal Code: | 295755370 |
| Phone Number: | 8439951136 |
| Fax Number: | |
| NPI Enumeration Date: | 09/24/2012 |
| NPI Last Update Date: | 09/24/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 271 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |