Provider Demographics
NPI:1740754928
Name:LOVE, OLIVIA RENEE (RD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:RENEE
Last Name:LOVE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12 BELLWETHER WAY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2959
Mailing Address - Country:US
Mailing Address - Phone:360-230-8202
Mailing Address - Fax:360-682-3731
Practice Address - Street 1:4500 9TH AVE NE STE 300
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4762
Practice Address - Country:US
Practice Address - Phone:360-230-8202
Practice Address - Fax:360-682-3732
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WADI60919441133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1016264Medicaid