Provider Demographics
NPI:1013199694
Name:MUCKRIDGE, JANET LEE (RD LD)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:LEE
Last Name:MUCKRIDGE
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 NORTH INTERSTATE AVENUE
Mailing Address - Street 2:NUTRITION DEPARTMENT EAST INTERSTATE
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1097
Mailing Address - Country:US
Mailing Address - Phone:503-286-6871
Mailing Address - Fax:
Practice Address - Street 1:3550 N INTERSTATE AVE
Practice Address - Street 2:NUTRITION DEPARTMENT EAST INTERSTATE
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1196
Practice Address - Country:US
Practice Address - Phone:503-286-6871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR737133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered