Provider Demographics
NPI:1376172437
Name:OLSEN, MARIANNE CROFT (RD)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:CROFT
Last Name:OLSEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 BELL RD UNIT 115
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8104
Mailing Address - Country:US
Mailing Address - Phone:435-592-1183
Mailing Address - Fax:
Practice Address - Street 1:4333 BELL RD UNIT 115
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8104
Practice Address - Country:US
Practice Address - Phone:435-592-1183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4868274-4901133V00000X
UT86088484133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered