Provider Demographics
NPI:1437305315
Name:LEE, ILEANA KARMIE (RDN, LDN, CDCES)
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:KARMIE
Last Name:LEE
Suffix:
Gender:F
Credentials:RDN, LDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 N INTERSTATE AVENUE
Mailing Address - Street 2:INTERSTATE MEDICAL OFFICE EAST, NUTRITION DEPARTMENT
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1097
Mailing Address - Country:US
Mailing Address - Phone:503-249-6705
Mailing Address - Fax:503-331-6319
Practice Address - Street 1:9800 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9750
Practice Address - Country:US
Practice Address - Phone:503-571-3040
Practice Address - Fax:503-570-3418
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR724133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered