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Lola Louise Amdahl

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

1600 Congress St Ste B, Portland, ME 04102-2148

PECOS Enrollment

This provider is enrolled in PECOS as LOLA AMDAHL.

Based on the most recent information from CMS, provider Lola Louise Amdahl is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 2:35 PM.

Profile Details

Provider ID
1487291050
Provider Type
Individual
Full Name
Amdahl, Lola Louise
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
12/3/2019
Last Updated
9/12/2022

Contact Information

Practice Location

1600 Congress St Ste B, Portland, ME 04102-2148

(207) 774-5222

Unlisted Fax

Mailing Location

557 Ocean St, South Portland, ME 04106-6625

(603) 252-0556

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA2334 Maine
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 055-0031471 Vermont
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Lola Louise Amdahl

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

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