Healthcare Provider Details

I. General information

NPI: 1164835138
Provider Name (Legal Business Name): AMANDA SUE OLBERDING DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA SUE HARRIS DO

II. Dates (important events)

Enumeration Date: 06/08/2014
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 WEST MAIN ST
MANCHESTER IA
52057
US

IV. Provider business mailing address

PO BOX 359
MANCHESTER IA
52057-0359
US

V. Phone/Fax

Practice location:
  • Phone: 563-927-7526
  • Fax:
Mailing address:
  • Phone: 563-927-7526
  • Fax: 563-927-7683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO-04753
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: