Provider Demographics
NPI:1417282682
Name:TOBIN, LOIS AMY (RD,CSR,LD)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:AMY
Last Name:TOBIN
Suffix:
Gender:F
Credentials:RD,CSR,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13520 SW AERIE DR
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2807
Mailing Address - Country:US
Mailing Address - Phone:503-524-4541
Mailing Address - Fax:
Practice Address - Street 1:6902 SE LAKE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-2148
Practice Address - Country:US
Practice Address - Phone:503-786-1148
Practice Address - Fax:503-786-1170
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal