Provider Demographics
NPI:1659441921
Name:OLSON, CRAIG ANDREW (MS, RD)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ANDREW
Last Name:OLSON
Suffix:
Gender:M
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 BERGQUIST DR STE 1
Mailing Address - Street 2:ATTN CREDENTIALS (CMC)
Mailing Address - City:LACKLAND A F B
Mailing Address - State:TX
Mailing Address - Zip Code:78236-9908
Mailing Address - Country:US
Mailing Address - Phone:210-292-5020
Mailing Address - Fax:210-292-7826
Practice Address - Street 1:2200 BERGQUIST DR STE 1
Practice Address - Street 2:ATTN CREDENTIALS (CMC)
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-9908
Practice Address - Country:US
Practice Address - Phone:210-292-5020
Practice Address - Fax:210-292-7826
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered