Individual
LEATRICE OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3509 E 29TH ST, DES MOINES, IA 50317-4253
(515) 248-1600
(515) 248-1610
Mailing address
9943 HICKMAN RD, SUITE 105, URBANDALE, IA 50322-5304
(515) 248-1447
(515) 248-1440
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01876
IA
207R00000X
Internal Medicine Physician
Primary
DO-01876
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2218511
—
IA
01
—
I99090051
MEDICARE PTAN
IA
Enumeration date
08/04/2006
Last updated
09/10/2014
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