Lola Louise Amdahl, PA-C
Physician Assistant in Portland, ME. Individual provider (NPI-1).
NPI number1487291050
StatusActive
Last updated in NPPESSep 12, 2022
Details
- NPI
- 1487291050
- Entity type
- Individual (NPI-1)
- Name
- Lola Louise Amdahl
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Dec 3, 2019
- Certification date
- Sep 12, 2022
- Last updated
- Sep 12, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | PA2334 | ME | Yes |
| 363A00000X | Physician Assistant | 055-0031471 | VT | |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
1600 Congress St Ste BPortland, ME 04102-2148
Phone 207-774-5222
Mailing address
557 Ocean StSouth Portland, ME 04106-6625
Phone 603-252-0556
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