Provider Demographics
NPI:1205821444
Name:OLSON, JENNIFER MAE (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MAE
Last Name:OLSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-358-7300
Mailing Address - Fax:515-358-7341
Practice Address - Street 1:2755 S. GATEWAY DRIVE
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:IA
Practice Address - Zip Code:50047-2301
Practice Address - Country:US
Practice Address - Phone:515-358-7300
Practice Address - Fax:515-358-7341
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-03043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0101048OtherUHC37
0172510OtherMEDIP
011135OtherSECURECARE
369909500OtherWCDFR
IA45789OtherWELLMARK
564903OtherCOVPC
G73793Medicare UPIN
IA151802OtherNORWE
IA119601OtherCOVENTRY
119601OtherCOVOP
IA45789OtherBLUE SHIELD
080133040OtherTRMED
14955OtherHCP
420870851OtherCOMMERCIAL
IA45789Medicare ID - Type Unspecified
IA0172510Medicaid
IA0104OtherHERITAGE
883979OtherL234
0926750001OtherDMERC