Healthcare Provider Details

I. General information

NPI: 1306438106
Provider Name (Legal Business Name): CARA OLOFSSON RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 W DRAKE RD STE 232
FORT COLLINS CO
80526-2880
US

IV. Provider business mailing address

343 W DRAKE RD STE 232
FORT COLLINS CO
80526-2880
US

V. Phone/Fax

Practice location:
  • Phone: 708-717-7394
  • Fax: 720-306-3508
Mailing address:
  • Phone: 708-717-7394
  • Fax: 720-306-3508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1066529
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: