Provider Demographics
NPI:1457773632
Name:OLMOS, KRISTEN CRAIG (MPH, RD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:CRAIG
Last Name:OLMOS
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 E 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3295
Mailing Address - Country:US
Mailing Address - Phone:541-915-5204
Mailing Address - Fax:541-485-7838
Practice Address - Street 1:280 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3295
Practice Address - Country:US
Practice Address - Phone:541-915-5204
Practice Address - Fax:541-485-7838
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR942133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered