Provider Demographics
NPI:1265673016
Name:OLSON, STEPHANIE LYNN (RD, CDE)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:OLSON
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 E RIVER RD
Mailing Address - Street 2:UNIVERSITY MEDICAL CENTER CORPORATION
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5840
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:655 E RIVER RD
Practice Address - Street 2:UNIVERSITY MEDICAL CENTER CORPORATION
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5840
Practice Address - Country:US
Practice Address - Phone:520-694-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-07
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ884982133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ70792Medicare PIN