MR. DEWAINE ALLEN OLSON JR. (NPI# 1720210248) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720210248 |
| Entity Type | Individual |
| Full Name | MR. DEWAINE ALLEN OLSON JR. |
| Practice Address |
559 Vincent St Peterson Afb CO 80914 |
| Practice Telephone | 7194743862 |
| Mailing Telephone | 7194743862 |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2009-08-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1003X |
Military Health Care Provider Specialization: Independent Duty Medical Technicians |
Other Service Providers |
| Street Address |
559 VINCENT ST |
| City | PETERSON AFB |
| State | CO |
| Zip Code | 80914 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891797080 | Keith Andrew Baker | Family Medicine | 559 Vincent St, 21 Mdos/sgof -fam Hlth, Peterson Afb, CO 80914-1540 | 2005-06-01 |
| 1912475740 | Julian G Fiorina | Family Medicine | 559 Vincent St, Peterson Afb, CO 80914-1541 | 2018-11-09 |
| 1740776970 | Chelsea M. Cruz | Nurse Practitioner | 559 Vincent St, Peterson Afb, CO 80914-1541 | 2018-07-11 |
| 1376036665 | Emillie Claire Brandt | Dentist | 559 Vincent St, Peterson Afb, CO 80914-1541 | 2018-06-11 |
| 1164911053 | Renee Antoinette Smith | Dentist | 559 Vincent St, Peterson Afb, CO 80914-1540 | 2018-05-07 |
| 1720582448 | Cristina Cosner | Military Health Care Provider | 559 Vincent St, Attn: 21 Mdos/sgof - Flight Med, Peterson Afb, CO 80914-1540 | 2018-03-19 |
| 1619476504 | Clarissa Reno | Registered Nurse | 559 Vincent St, Peterson Afb, CO 80914-1541 | 2018-02-06 |
| 1891159463 | Tialicka Burgos Johnson | Registered Nurse | 559 Vincent St, Attn: 21 Mdos/sgog - Women's Health, Peterson Afb, CO 80914-1540 | 2016-04-11 |
| 1114385747 | Jeffrey A Turner | Physical Therapist | 559 Vincent St, Attn: 21 Mdos/sgoy - Physical Therapy, Peterson Afb, CO 80914-1540 | 2016-02-10 |
| 1689046500 | Christine Chanmyaethu Tun | Physician Assistant | 559 Vincent St, Attn: 21 Mods/sgof - Family Health, Peterson Afb, CO 80914-1540 | 2015-10-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356897250 | Kym Littlefield Whitaker | Nurse Practitioner | 110 Ent Avenue, Peterson Afb, CA 80914 | 2016-08-30 |
| 1114322583 | Jessica Charmaine Johnson | Social Worker | 559 Vincent St, Bldg 959, Attn: 21 Omrs/sgow, Peterson Afb, CO 80914 | 2014-10-28 |
| 1306916267 | John Frank Drozd | Psychologist | 21st Medical Group, 559 Vincent Street, Peterson Afb, CO 80914 | 2006-11-08 |
| 1801858865 | Moshe Mark Douglas Wexler | Clinical Neuropsychologist | 110 W. Ent Ave. Bldg 725, 21 Mdos/sgoh, Pafb, CO 80914 | 2006-04-05 |
| 1215902002 | William J Dickson | Dentist | Peterson Afb, Bld 950, Colorado Springs, CO 80914 | 2006-02-23 |
| 1740889773 | Brandon Dean Estes | Dental Hygienist | 1055 Stewart Ave, Bldg 2018, Apo, AA 80914 | 2020-10-21 |
| 1225458789 | Brianna Mcmurray | Family Medicine | 559 Vincent St Bldg 959, Colorado Springs, CO 80914 | 2014-04-23 |
| 1720406796 | Beth D Achterhoff | Physical Therapist | 559 Vincent St Bldg 959, Peterson Afb, CO 80914 | 2014-04-07 |
| 1275712895 | Monica Ibarra | Counselor | 559 Vincent St., Attn: 21 Mdos/sgow - Family Advocacy, Peterson Afb, CO 80914 | 2007-10-31 |
| 1912258591 | Ruth Angela Monsanto-williams | Nurse Practitioner | 110 West Ent Ave, Peterson Afb, 21st Medical Group, Colorado Springs, CO 80914-1540 | 2012-09-24 |
| Find all providers in zip 80914 | ||||
| Taxonomy Code | 1710I1003X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Medical Technicians |
| An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision. An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT. An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility. IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians. |
| Notes: Source: Air Force Surgeon General Office [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255754214 | Lynor Dicang Hardy | Military Health Care Provider | Cheyenne Mountain Air Station, Colorado Springs, CO 80922 | 2014-01-28 |
| 1912243239 | Lerinda Kay Carle | Military Health Care Provider | 6676 Myrtle Creek Dr, Colorado Springs, CO 80927-4034 | 2012-12-13 |
| 1558611103 | Darin Lee Hoki | Military Health Care Provider | 19471 E. Brunswick Dr., Aurora, CO 80013 | 2012-09-11 |
| 1851675011 | Susanne Clariece Fry | Military Health Care Provider | 2540 Brady Dr, Colorado Springs, CO 80917-4021 | 2011-10-06 |
| 1780968859 | Lindsey Shanks | Military Health Care Provider | 30330 Palomino Dr, Evergreen, CO 80439-8602 | 2011-10-06 |
| 1881977312 | Brande Nicole Sims | Military Health Care Provider | 605 Harvest Field Way, Fountain, CO 80817-3185 | 2011-09-21 |
| 1518289115 | Renee Jean Cole | Military Health Care Provider | 4515 East Juniper Dr Unit A, Usaf Academy, CO 80840 | 2010-02-23 |
| 1588996243 | Luke William Willis | Military Health Care Provider | 1965 Shawnee Dr, Colorado Springs, CO 80915-1920 | 2010-02-05 |
| 1881838563 | James Edwin Dixon | Military Health Care Provider | 1 William White Blvd, Pueblo, CO 81001-4829 | 2009-04-27 |
| 1063655140 | Gregory S. Brooks | Military Health Care Provider | 2355 Faculty Dr Suite 1n207, 10th Amds, Usafa, CO 80840 | 2009-04-20 |
| Find all providers with the same taxonomy | ||||
| City | PETERSON AFB |
| Zip Code | 80914 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.