Provider Demographics
NPI:1144424151
Name:KRIEWALL, LEAH JERENE (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:JERENE
Last Name:KRIEWALL
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:JERENE
Other - Last Name:BEITLICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:725 S WAHANNA RD
Mailing Address - Street 2:NUTRITION SERVICES PROVIDENCE SEASIDE HOSPITAL
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138-7735
Mailing Address - Country:US
Mailing Address - Phone:503-717-7290
Mailing Address - Fax:
Practice Address - Street 1:725 S WAHANNA RD
Practice Address - Street 2:NUTRITION SERVICES PROVIDENCE SEASIDE HOSPITAL
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-7735
Practice Address - Country:US
Practice Address - Phone:503-717-7290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR775133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered