Provider Demographics
NPI:1144985110
Name:OLSON, DAWNMARIE (CHN,CCMA,NRT,EMT)
Entity type:Individual
Prefix:
First Name:DAWNMARIE
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:CHN,CCMA,NRT,EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N8157 HARDING RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:WI
Mailing Address - Zip Code:54659-8106
Mailing Address - Country:US
Mailing Address - Phone:715-457-5045
Mailing Address - Fax:
Practice Address - Street 1:N8157 HARDING RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:WI
Practice Address - Zip Code:54659-8106
Practice Address - Country:US
Practice Address - Phone:715-457-5045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9137133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist