Healthcare Provider Details

I. General information

NPI: 1033108477
Provider Name (Legal Business Name): THERESE M MOLLINGER OLSON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 SUNSET PL MEMORIAL HOSPITAL INC
NEILLSVILLE WI
54456-1706
US

IV. Provider business mailing address

E1615 BALSAM RD
ELEVA WI
54738-9428
US

V. Phone/Fax

Practice location:
  • Phone: 715-743-3101
  • Fax: 715-743-6245
Mailing address:
  • Phone: 715-878-9881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number661634
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: