Provider Demographics
NPI:1407847197
Name:OLSON, JOHN HARRISON (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HARRISON
Last Name:OLSON
Suffix:
Gender:M
Credentials:PA-C
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:515-643-8100
Mailing Address - Fax:515-643-8139
Practice Address - Street 1:800 E 1ST ST
Practice Address - Street 2:SUITE 1700
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-2077
Practice Address - Country:US
Practice Address - Phone:515-643-8100
Practice Address - Fax:515-643-8139
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00696363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA71153OtherWELLMARK BLUE SHIELD
IA71153OtherWELLMARK BLUE SHIELD
IAI21840Medicare PIN
IAI21839Medicare PIN
IA20641Medicare PIN