Provider Demographics
NPI:1992188155
Name:MATHISEN-HOLLOMAN, OLIVIA DANIELLE (RDN)
Entity Type:Individual
Prefix:MISS
First Name:OLIVIA
Middle Name:DANIELLE
Last Name:MATHISEN-HOLLOMAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18720 76TH AVE W APT B
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-5806
Mailing Address - Country:US
Mailing Address - Phone:206-639-0225
Mailing Address - Fax:
Practice Address - Street 1:18720 76TH AVE W APT B
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-5806
Practice Address - Country:US
Practice Address - Phone:206-639-0225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA86037656133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered