Provider Demographics
NPI:1770112740
Name:KRAS, OLGA
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:KRAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29742 N ENVIRON CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1170
Mailing Address - Country:US
Mailing Address - Phone:847-644-7270
Mailing Address - Fax:
Practice Address - Street 1:29742 N ENVIRON CIR
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1170
Practice Address - Country:US
Practice Address - Phone:847-644-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.001890133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered