Provider Demographics
NPI:1760124432
Name:MOELLER, OLIVIA (MS CNS)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:MOELLER
Suffix:
Gender:F
Credentials:MS CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 S SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-1618
Mailing Address - Country:US
Mailing Address - Phone:949-294-3434
Mailing Address - Fax:
Practice Address - Street 1:2711 S SHERMAN ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-1618
Practice Address - Country:US
Practice Address - Phone:949-294-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist