Provider Demographics
NPI:1518401405
Name:PHILLIPS, OLIVIA ANN (RDN)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:ANN
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2800 S SHIRLINGTON RD
Mailing Address - Street 2:#505
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-3601
Mailing Address - Country:US
Mailing Address - Phone:703-807-0037
Mailing Address - Fax:
Practice Address - Street 1:2800 S SHIRLINGTON RD
Practice Address - Street 2:#505
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-3601
Practice Address - Country:US
Practice Address - Phone:330-285-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI00000818133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered