Provider Demographics
NPI:1457116873
Name:WHITAKER, OLIVIA (MS, RDN, CLC)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:MS, RDN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CROSSWINDS WAY
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-2714
Mailing Address - Country:US
Mailing Address - Phone:864-542-5687
Mailing Address - Fax:
Practice Address - Street 1:7 CROSSWINDS WAY
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-2714
Practice Address - Country:US
Practice Address - Phone:864-542-5687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
SC1361133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN