Provider Demographics
NPI:1689754996
Name:OLSON, SUSAN E (RD,LD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:OLSON
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BUTTRICK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3417
Mailing Address - Country:US
Mailing Address - Phone:603-537-1300
Mailing Address - Fax:
Practice Address - Street 1:14A TSIENNETO RD
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038
Practice Address - Country:US
Practice Address - Phone:603-537-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered