Provider Demographics
NPI:1194115501
Name:OLSEN, NATALIE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:OLSEN
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 1:12445 ALAMEDA TRACE CIR
Mailing Address - Street 2:#1014
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-6390
Mailing Address - Country:US
Mailing Address - Phone:970-988-2106
Mailing Address - Fax:
Practice Address - Street 1:12445 ALAMEDA TRACE CIR
Practice Address - Street 2:#1014
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-6390
Practice Address - Country:US
Practice Address - Phone:970-988-2106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83416133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered