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Contact Information

PORTLAND PEDIATRIC NUTRITION
1730 SW SKYLINE BLVD STE 226
PORTLAND, OR97221-2549
 Phone: 971-319-1288
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dietitian, Registered

133V00000X 71 Registered Dietitian or Nutrition Professional
 

Nutrition, Pediatric

133VN1004X 71 Registered Dietitian or Nutrition Professional
Indicates primary specialty

NPI Profile & details for PORTLAND PEDIATRIC NUTRITION · (Female)

NPI Number 1972012409
Status Active
Credentials
Entity Individual
Enumeration date 09/27/2017
Last updated 03/17/2018 - About 8 years ago
Sole proprietor 1 Not specified
Identifiers
  • OR License # LD-D-000479
  • WA License # DI60717826
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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