Provider Demographics
NPI:1134573504
Name:OLSON, MARIE (NTP, RWP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:NTP, RWP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3485
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23663-0485
Mailing Address - Country:US
Mailing Address - Phone:253-588-1154
Mailing Address - Fax:
Practice Address - Street 1:12 NICOLE CT
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-1691
Practice Address - Country:US
Practice Address - Phone:253-588-1154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist