Provider Demographics
NPI:1558745968
Name:TENNEY, OLGA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:TENNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:STRUEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1801 HICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-1597
Mailing Address - Country:US
Mailing Address - Phone:515-282-2700
Mailing Address - Fax:515-282-2733
Practice Address - Street 1:1801 HICKMAN RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-1597
Practice Address - Country:US
Practice Address - Phone:515-282-2700
Practice Address - Fax:515-282-2733
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-44914208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program