Provider Demographics
NPI:1336624584
Name:OLSEN, MEGAN TAYLOR LANE (RDN)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:TAYLOR LANE
Last Name:OLSEN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 4TH AVE SE STE B
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2425
Mailing Address - Country:US
Mailing Address - Phone:319-298-2200
Mailing Address - Fax:319-298-2299
Practice Address - Street 1:1002 4TH AVE SE STE B
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2425
Practice Address - Country:US
Practice Address - Phone:319-298-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091791133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered