Provider Demographics
NPI:1194739540
Name:OLSON, JENNIFER ANN (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:OLSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:747 52ND STREET
Mailing Address - Street 2:CHILDRENS HOSPITAL AND RESEARCH CENTER OF OAKLAND ENDOC
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1809
Mailing Address - Country:US
Mailing Address - Phone:510-428-3654
Mailing Address - Fax:510-450-5614
Practice Address - Street 1:747 52ND STREET
Practice Address - Street 2:CHRCO ENDOCRINOLOGY
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3654
Practice Address - Fax:510-450-5614
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA0551422080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A551420Medicaid
H17274Medicare UPIN