Provider Demographics
NPI:1538876156
Name:NW DIETITIAN LLC
Entity type:Organization
Organization Name:NW DIETITIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ZEDNIA
Authorized Official - Middle Name:CAROLINA
Authorized Official - Last Name:LINARES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD
Authorized Official - Phone:503-756-4191
Mailing Address - Street 1:2455 NE JUNIPER AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2928
Mailing Address - Country:US
Mailing Address - Phone:503-756-4191
Mailing Address - Fax:866-462-2818
Practice Address - Street 1:2455 NE JUNIPER AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2928
Practice Address - Country:US
Practice Address - Phone:503-756-4191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty