Provider Demographics
NPI:1740503721
Name:OLMSTEAD, CATHERINE M (RD)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:M
Last Name:OLMSTEAD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-2253
Mailing Address - Country:US
Mailing Address - Phone:845-858-7795
Mailing Address - Fax:845-858-7420
Practice Address - Street 1:160 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-2253
Practice Address - Country:US
Practice Address - Phone:845-858-7795
Practice Address - Fax:845-858-7420
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0038961133NN1002X
NY667772133V00000X
NYCDE 20620341133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic