Provider Demographics
NPI:1598896375
Name:OLSON, CHRISTINE CAROL (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:CAROL
Last Name:OLSON
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 1:5916 NW 162ND ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-9738
Mailing Address - Country:US
Mailing Address - Phone:405-830-9661
Mailing Address - Fax:
Practice Address - Street 1:1000 N LINCOLN BLVD STE 2900
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-3252
Practice Address - Country:US
Practice Address - Phone:405-271-7552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1185133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKMCN-02-02043-001-021Medicare ID - Type Unspecified