Most Relevant Information
Provider Data
| NPI Number: | 1003238387 |
| Provider Name: | NICOLE LYNN OLEN RDN, CHC |
| Entity Type: | Individual |
| Taxonomy Code: | 133V00000X |
| Specialty: | Dietitian, Registered |
| License Number: | 164.006005 |
Most Important Dates
| Enumeration Date: | 01/06/2014 |
| Last Updated: | 03/17/2018 |
Provider Practice Location
9014 W 96TH AVE
SAINT JOHN
IN
463738978
Practice Location Phone/Fax
| Phone: | 2196291176 |
| Fax: |
Provider Mailing Location
9014 W 96TH AVE
SAINT JOHN
IN
463738978
Provider Mailing Phone/Fax
| Phone: | 2196291176 |
| Fax: |