Provider Demographics
NPI:1861892531
Name:LARSON STURTEVANT CONSULTING, LLC
Entity type:Organization
Organization Name:LARSON STURTEVANT CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN/TRAINER/MENTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:STURTEVANT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:503-288-4104
Mailing Address - Street 1:3719 N WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1440
Mailing Address - Country:US
Mailing Address - Phone:503-288-4104
Mailing Address - Fax:503-287-4955
Practice Address - Street 1:3719 N WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1440
Practice Address - Country:US
Practice Address - Phone:503-288-4104
Practice Address - Fax:503-287-4955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR777133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty