Provider Demographics
NPI:1417726324
Name:THIEDE, OLIVIA MARIE (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:MARIE
Last Name:THIEDE
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 SUPERIOR LN NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3314
Mailing Address - Country:US
Mailing Address - Phone:507-271-3763
Mailing Address - Fax:
Practice Address - Street 1:4221 W CIRCLE DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8788
Practice Address - Country:US
Practice Address - Phone:515-695-3796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5167133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered