Provider Demographics
NPI:1508613332
Name:OLIVIO, HOLLY (MS, RDN, LDN, CNSC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:OLIVIO
Suffix:
Gender:F
Credentials:MS, RDN, LDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 N HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:MOWEAQUA
Mailing Address - State:IL
Mailing Address - Zip Code:62550-1025
Mailing Address - Country:US
Mailing Address - Phone:217-820-9380
Mailing Address - Fax:
Practice Address - Street 1:337 N HANOVER ST
Practice Address - Street 2:
Practice Address - City:MOWEAQUA
Practice Address - State:IL
Practice Address - Zip Code:62550-1025
Practice Address - Country:US
Practice Address - Phone:217-820-9380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164007162133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered