MEDICARE: OLIVIA MAY HIRSCH RDN, LDN

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	3289	LA

General Provider Information

NPI Number	:	1215609599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA MAY HIRSCH RDN, LDN

Provider Business Mailing Address
First Line	:	4058 RICHMOND AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-1032
Country	:	US
Telephone Number	:	131-834-7564
Fax Number	:

Provider Business Practice Location Address
First Line	:	4058 RICHMOND AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-1032
Country	:	US
Telephone Number	:	131-834-7564
Fax Number	:

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

Provider Enumeration Date	:	10/04/2021
Last Update Date	:	10/04/2021

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