Healthcare Provider Details

I. General information

NPI: 1710843982
Provider Name (Legal Business Name): OLIVIA HANSEN RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLIVIA MOMOSOR RDN

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9099 S BONNET DR
SANDY UT
84093-2212
US

IV. Provider business mailing address

9099 S BONNET DR
SANDY UT
84093-2212
US

V. Phone/Fax

Practice location:
  • Phone: 801-930-0128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: