Active NPI
Alicia Marie Olsen
- Registered Dietitian
- Oswego, NY
National Provider Identifier
1164876702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 0086041
- Practice address
- 140 W 6TH St
Oswego, NY 13126-2525 - Phone
- (315) 349-5511
- Fax
- (315) 349-5823
- NPI assigned
- Apr 20, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 0086041 | NY | Primary |
Addresses
Primary practice location
140 W 6TH St
Oswego, NY 13126-2525
Mailing address
110 W 6TH St
Oswego, NY 13126-2507
Phone (315) 349-5511
Other practice location 1
177 W 4th St
Oswego, NY 13126-3009
Phone (315) 343-2151
Other practice location 2
17 Lansing St
Auburn, NY 13021-1983
Phone (315) 255-7011
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 86032629 | Other | COMMISSION ON DIETETIC REGISTRATION | |
| 0086041 | Other | NY | STATE OF NEW YORK EDUCATION DEPARTMENT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 008604 | NY | MD | Clinical Psychologist |
| 0086041 | NY | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680048000000",
"number": "1164876702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 W 6TH ST",
"city": "OSWEGO",
"state": "NY",
"postal_code": "131262507",
"telephone_number": "315-349-5511",
"fax_number": "315-349-5921"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 W 6TH ST",
"city": "OSWEGO",
"state": "NY",
"postal_code": "131262525",
"telephone_number": "315-349-5511",
"fax_number": "315-349-5823"
}
],
"practiceLocations": [
{
"address_1": "177 W 4th St",
"address_purpose": "LOCATION",
"city": "Oswego",
"state": "NY",
"postal_code": "131263009",
"country_code": "US",
"telephone_number": "315-343-2151",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "17 Lansing St",
"address_purpose": "LOCATION",
"city": "Auburn",
"state": "NY",
"postal_code": "130211983",
"country_code": "US",
"telephone_number": "315-255-7011",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "OLSEN",
"first_name": "ALICIA",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-04-20",
"last_updated": "2023-03-29",
"certification_date": "2023-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "0086041",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMISSION ON DIETETIC REGISTRATION",
"identifier": "86032629",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF NEW YORK EDUCATION DEPARTMENT",
"identifier": "0086041",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oswego, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.