Healthcare Provider Details

I. General information

NPI: 1447268198
Provider Name (Legal Business Name): LEATRICE OLSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 E 29TH ST
DES MOINES IA
50317-4253
US

IV. Provider business mailing address

9943 HICKMAN RD SUITE 105
URBANDALE IA
50322-5304
US

V. Phone/Fax

Practice location:
  • Phone: 515-248-1600
  • Fax: 515-248-1610
Mailing address:
  • Phone: 515-248-1447
  • Fax: 515-248-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01876
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO-01876
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: