Basic Information
| Provider Information | |||||||||
| NPI: | 1811990906 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLSON | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 165 NATCHEZ TRACE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421037947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707827800 | ||||||||
| FaxNumber: | 2708430779 | ||||||||
| Practice Location | |||||||||
| Address1: | 165 NATCHEZ TRACE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421037947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707827800 | ||||||||
| FaxNumber: | 2708430779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 09/08/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 21044 | KY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 64210446 | 05 | KY | MEDICAID | 000000050854 | 01 | KY | ANTHEM | OTHER |