Healthcare Provider Details

I. General information

NPI: 1659112167
Provider Name (Legal Business Name): OLIVIA ROSE STRIGGOW CN, MS IFN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

886 N PARK ST
LYNDEN WA
98264-8587
US

IV. Provider business mailing address

886 N PARK ST
LYNDEN WA
98264-8587
US

V. Phone/Fax

Practice location:
  • Phone: 360-961-3810
  • Fax:
Mailing address:
  • Phone: 360-961-3810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNU61515778
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberNU61515778
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: