Provider Demographics
NPI:1124257019
Name:RYDBERG FREESE, LENA KRISTINE (DO)
Entity type:Individual
Prefix:DR
First Name:LENA
Middle Name:KRISTINE
Last Name:RYDBERG FREESE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LENA
Other - Middle Name:KRISTINE
Other - Last Name:RYDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50302-0424
Mailing Address - Country:US
Mailing Address - Phone:515-875-9255
Mailing Address - Fax:515-875-9223
Practice Address - Street 1:5950 UNIVERSITY AVE STE 151
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266
Practice Address - Country:US
Practice Address - Phone:515-875-9192
Practice Address - Fax:515-875-9193
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006013207R00000X
IADO-04787207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine