Provider Demographics
NPI:1215609599
Name:HIRSCH, OLIVIA MAY (RDN, LDN)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MAY
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4058 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-1032
Mailing Address - Country:US
Mailing Address - Phone:131-834-7564
Mailing Address - Fax:
Practice Address - Street 1:4058 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-1032
Practice Address - Country:US
Practice Address - Phone:131-834-7564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3289133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered