Individual
LEATRICE OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
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
Update your record
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