Provider Demographics
NPI:1427886167
Name:LUTHER, OLIVIA (RD, MS)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:LUTHER
Suffix:
Gender:F
Credentials:RD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10273 OAK BANK CV
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-8545
Mailing Address - Country:US
Mailing Address - Phone:901-389-0798
Mailing Address - Fax:
Practice Address - Street 1:10273 OAK BANK CV
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:TN
Practice Address - Zip Code:38002-8545
Practice Address - Country:US
Practice Address - Phone:901-389-0798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered