MEDICARE: THERESE M MOLLINGER OLSON RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	661634	WI

General Provider Information

NPI Number	:	1033108477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESE M MOLLINGER OLSON RD

Provider Business Mailing Address
First Line	:	E1615 BALSAM RD
Second Line	:
City	:	ELEVA
State	:	WI
Zip	:	54738-9428
Country	:	US
Telephone Number	:	715-878-9881
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 SUNSET PL
Second Line	:	MEMORIAL HOSPITAL INC
City	:	NEILLSVILLE
State	:	WI
Zip	:	54456-1706
Country	:	US
Telephone Number	:	715-743-3101
Fax Number	:	715-743-6245

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	07/08/2007

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