Provider Demographics
NPI:1396044772
Name:OLSSON, LANA LOUISE (RD, CSG)
Entity Type:Individual
Prefix:MS
First Name:LANA
Middle Name:LOUISE
Last Name:OLSSON
Suffix:
Gender:F
Credentials:RD, CSG
Other - Prefix:MISS
Other - First Name:LANA
Other - Middle Name:LOUISE
Other - Last Name:LUXENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:5624 BRIANNA LN
Mailing Address - Street 2:
Mailing Address - City:BELLVUE
Mailing Address - State:CO
Mailing Address - Zip Code:80512-5850
Mailing Address - Country:US
Mailing Address - Phone:970-482-3951
Mailing Address - Fax:
Practice Address - Street 1:1136 E STUART ST STE 101
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1195
Practice Address - Country:US
Practice Address - Phone:970-443-9148
Practice Address - Fax:970-232-9367
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY216133V00000X
OH579546133V00000X
PADN000286133V00000X
CO579546133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY216OtherLICENSE
579546OtherACADEMY OF NUTRITION & DIETETICS REGISTRATION