MEDICARE: DAWNMARIE OLSON CHN,CCMA,NRT,EMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist	9137	WI

General Provider Information

NPI Number	:	1144985110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWNMARIE OLSON CHN,CCMA,NRT,EMT

Provider Business Mailing Address
First Line	:	N8157 HARDING RD
Second Line	:
City	:	TAYLOR
State	:	WI
Zip	:	54659-8106
Country	:	US
Telephone Number	:	715-457-5045
Fax Number	:

Provider Business Practice Location Address
First Line	:	N8157 HARDING RD
Second Line	:
City	:	TAYLOR
State	:	WI
Zip	:	54659-8106
Country	:	US
Telephone Number	:	715-457-5045
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2021
Last Update Date	:	11/04/2021

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