Provider Demographics
NPI:1851834600
Name:OLSON, SHELBY LEE (MS, LN)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:LEE
Last Name:OLSON
Suffix:
Gender:F
Credentials:MS, LN
Other - Prefix:MISS
Other - First Name:SHELBY
Other - Middle Name:LEE
Other - Last Name:HUMMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LN
Mailing Address - Street 1:45 SNELLING AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6842
Mailing Address - Country:US
Mailing Address - Phone:651-699-3438
Mailing Address - Fax:
Practice Address - Street 1:45 SNELLING AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6842
Practice Address - Country:US
Practice Address - Phone:651-699-3438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNN222133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist