MEDICARE: MRS. OLIVIA MARIE THIEDE MS, RD, LD

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	5167	MN

General Provider Information

NPI Number	:	1417726324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. OLIVIA MARIE THIEDE MS, RD, LD

Provider Business Mailing Address
First Line	:	2335 SUPERIOR LN NW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-3314
Country	:	US
Telephone Number	:	507-271-3763
Fax Number	:

Provider Business Practice Location Address
First Line	:	4221 W CIRCLE DR NW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-8788
Country	:	US
Telephone Number	:	515-695-3796
Fax Number	:

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

Provider Enumeration Date	:	12/20/2023
Last Update Date	:	12/20/2023

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