Provider Demographics
NPI:1932202991
Name:OLSON, JENNIFER ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:OLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PARKWAY
Mailing Address - Street 2:MEDICAL STAFF SVCS.
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-4088
Mailing Address - Fax:765-966-2596
Practice Address - Street 1:1471 CHESTER BLVD.
Practice Address - Street 2:STE. A, REID INTERNAL MEDICINE
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1946
Practice Address - Country:US
Practice Address - Phone:765-935-4088
Practice Address - Fax:765-966-2596
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.099622207R00000X
IL036112437207R00000X
IN01078252A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810023789Medicaid
OH0068627Medicaid
IL036112437Medicaid
IL036112437Medicaid
OH0068627Medicaid
OH0068627Medicaid