Provider Demographics
NPI:1376215905
Name:COX, OLIVIA DEBRA (RD)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:DEBRA
Last Name:COX
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:DEBRA
Other - Last Name:SUTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 BROOKLANE N
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-0005
Mailing Address - Country:US
Mailing Address - Phone:208-421-8695
Mailing Address - Fax:
Practice Address - Street 1:801 POLE LINE RD W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5810
Practice Address - Country:US
Practice Address - Phone:208-727-8494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered