Healthcare Provider Details

I. General information

NPI: 1134049752
Provider Name (Legal Business Name): MELISSA R OLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 2ND ST
GRAY IA
50110-2310
US

IV. Provider business mailing address

204 2ND ST
GRAY IA
50110-2310
US

V. Phone/Fax

Practice location:
  • Phone: 712-250-0511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberP57444
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: