Provider Demographics
NPI:1033392618
Name:SCHAEFER, KRISTA S (MS RDN LD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:S
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:MS RDN LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 MADISON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2354
Mailing Address - Country:US
Mailing Address - Phone:503-313-6461
Mailing Address - Fax:503-650-7002
Practice Address - Street 1:619 MADISON ST STE 102
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2354
Practice Address - Country:US
Practice Address - Phone:503-313-6461
Practice Address - Fax:503-650-7002
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORLD-D-10206136133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program