Provider Demographics
NPI:1285623439
Name:OLSON, JENNIFER LEA (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEA
Last Name:OLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 22ND AVE S
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2830
Mailing Address - Country:US
Mailing Address - Phone:605-697-1900
Mailing Address - Fax:605-697-1919
Practice Address - Street 1:922 22ND AVE S
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2830
Practice Address - Country:US
Practice Address - Phone:605-697-1900
Practice Address - Fax:605-697-1919
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5937207Q00000X
AK5215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1285623439OtherNPI
SDI23872Medicare UPIN
SDS101452Medicare PIN
AKI23872Medicare UPIN
SDP00403433Medicare PIN