Provider Demographics
NPI:1235467234
Name:GRAY, EEVA S (RD, CDE)
Entity Type:Individual
Prefix:
First Name:EEVA
Middle Name:S
Last Name:GRAY
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6902 SE LAKE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-2148
Mailing Address - Country:US
Mailing Address - Phone:503-786-1149
Mailing Address - Fax:503-786-1170
Practice Address - Street 1:6902 SE LAKE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-2148
Practice Address - Country:US
Practice Address - Phone:503-786-1149
Practice Address - Fax:503-786-1170
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR826133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered