Healthcare Provider Details

I. General information

NPI: 1386140911
Provider Name (Legal Business Name): EVAN OLSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 UNIVERSITY AVE STE 205
WEST DES MOINES IA
50266-8231
US

IV. Provider business mailing address

PO BOX 424
DES MOINES IA
50302-0424
US

V. Phone/Fax

Practice location:
  • Phone: 515-875-9290
  • Fax: 515-875-9291
Mailing address:
  • Phone: 515-875-9255
  • Fax: 515-875-9223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD-49217
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: