Provider Demographics
NPI:1811756075
Name:METABOLIC RDS
Entity type:Organization
Organization Name:METABOLIC RDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:NINA
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:262-331-0933
Mailing Address - Street 1:1008 LATHROP AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-2342
Mailing Address - Country:US
Mailing Address - Phone:262-331-0933
Mailing Address - Fax:
Practice Address - Street 1:807 WAUKEGAN RD STE 110
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-3227
Practice Address - Country:US
Practice Address - Phone:262-331-0933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty