Nicole Lynn Olen, RDN, CHC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

164.006005 Issued in IL

Practice address

9014 W 96TH Ave
Saint John, IN 46373-8978

Phone

(219) 629-1176

NPI assigned

Jan 6, 2014

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1388966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1003238387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9014 W 96TH AVE",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463738978",
            "telephone_number": "219-629-1176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9014 W 96TH AVE",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463738978",
            "telephone_number": "219-629-1176"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 park blvd",
            "address_purpose": "LOCATION",
            "city": "itaska",
            "state": "IL",
            "postal_code": "60143",
            "country_code": "US",
            "telephone_number": "630-345-5377",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OLEN",
        "first_name": "NICOLE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "RDN, CHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-06",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164.006005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tamara A Nicksic, PT
• Mia Nisle
• Northshore Health Centers, Inc. (NorthShore St. John Community Health Center)
• Northwest Pediatric Dental LLC (Southwest Pediatric Dental)
• Courtney Olavarria, RN
• Michael Olenik, PHARMD
• Erica Ortega
• Bina K Parekh, DO
• Park Place Christian Community of St. John, Inc.
• Nicole T. Parker, CCC-SLP

• Registered Dietitian in Saint John, IN
• Providers in Saint John, IN by specialty
• Registered Dietitian in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.