Provider Demographics
NPI:1235161928
Name:OLDHAM, LYNNE (PHD, RD, CDE, CHES)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:OLDHAM
Suffix:
Gender:F
Credentials:PHD, RD, CDE, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2676 NW PICKETT CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6807
Mailing Address - Country:US
Mailing Address - Phone:541-598-4179
Mailing Address - Fax:541-388-9261
Practice Address - Street 1:2036 NE WILLIAMSON CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3771
Practice Address - Country:US
Practice Address - Phone:541-706-6348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR653133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric