Healthcare Provider Details

I. General information

NPI: 1457773632
Provider Name (Legal Business Name): KRISTEN CRAIG OLMOS MPH, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 E 11TH AVE
EUGENE OR
97401-3295
US

IV. Provider business mailing address

280 E 11TH AVE
EUGENE OR
97401-3295
US

V. Phone/Fax

Practice location:
  • Phone: 541-915-5204
  • Fax: 541-485-7838
Mailing address:
  • Phone: 541-915-5204
  • Fax: 541-485-7838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number942
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: