Provider Demographics
NPI:1164743357
Name:OLSON, ALISA M (DO)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:M
Last Name:OLSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:M
Other - Last Name:CORDERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:814 PIERCE ST
Mailing Address - Street 2:STE 300
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1058
Mailing Address - Country:US
Mailing Address - Phone:712-226-2600
Mailing Address - Fax:712-226-2605
Practice Address - Street 1:2600 OUTER DR N
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-1585
Practice Address - Country:US
Practice Address - Phone:712-239-3300
Practice Address - Fax:712-239-8201
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-04219207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine