Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 28343 | IA |
NPI | 1003807900 |
---|---|
Provider Name | Dr. Maria L.m. Olberding |
First Address | Marshalltown, IA 50158-4443 |
Second Address | Marshalltown, IA 50158-4443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 16/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0158527 | (05) | IA |
F02146 | (02) | IA |