Individual
ALICIA MARIE OLSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
140 W 6TH ST, OSWEGO, NY 13126-2525
(315) 349-5511
(315) 349-5823
Mailing address
110 W 6TH ST, OSWEGO, NY 13126-2507
(315) 349-5511
(315) 349-5921
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
0086041
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0086041
STATE OF NEW YORK EDUCATION DEPARTMENT
NY
01
—
86032629
COMMISSION ON DIETETIC REGISTRATION
—
Enumeration date
04/20/2016
Last updated
03/29/2023
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