Provider Demographics
NPI:1255488920
Name:MCVEETY, KORINNE LYNN (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:KORINNE
Middle Name:LYNN
Last Name:MCVEETY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MISS
Other - First Name:KORINNE
Other - Middle Name:
Other - Last Name:UTTERBACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5225 TANOAK AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-1607
Mailing Address - Country:US
Mailing Address - Phone:503-383-8095
Mailing Address - Fax:
Practice Address - Street 1:1401 N 10TH AVE
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-1311
Practice Address - Country:US
Practice Address - Phone:503-769-4380
Practice Address - Fax:503-769-8563
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR704133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR132200Medicare PIN