1205821444 NPI number — DR. JENNIFER MAE OLSON DO

Table of content: DR. JENNIFER MAE OLSON DO (NPI 1205821444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205821444 NPI number — DR. JENNIFER MAE OLSON DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLSON
Provider First Name:
JENNIFER
Provider Middle Name:
MAE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205821444
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1475
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50305-1475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-358-7300
Provider Business Mailing Address Fax Number:
515-358-7341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2755 S. GATEWAY DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLISLE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50047-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-358-7300
Provider Business Practice Location Address Fax Number:
515-358-7341
Provider Enumeration Date:
09/14/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  DO-03043 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)