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NPI Code Detail

MEDICARE: LAURA OLSEN MNT

MEDICARE:   LAURA  OLSEN  MNT
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
1133V00000XRegistered Dietitian000212-1NY

General Provider Information

NPI Number : 1437238482
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA OLSEN MNT
Provider Business Mailing Address
First Line : 20 DICTUM CT
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-5938
Country : US
Telephone Number : 718-769-8820
Fax Number : 718-769-8558
Provider Business Practice Location Address
First Line : 2726 GERRITSEN AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-5915
Country : US
Telephone Number : 718-769-8820
Fax Number : 718-769-8558
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2006
Last Update Date : 07/08/2007

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