Provider Demographics
NPI:1013124106
Name:OLSON, ABBY MARIE (RD, LD)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:MARIE
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 1:2209 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4345
Mailing Address - Country:US
Mailing Address - Phone:651-207-7197
Mailing Address - Fax:877-992-0282
Practice Address - Street 1:680 COMMERCE DR STE 260
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4502
Practice Address - Country:US
Practice Address - Phone:651-207-7197
Practice Address - Fax:877-992-0282
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1648133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered