Provider Demographics
NPI:1467603043
Name:WHITSON, AI-LAN (RD)
Entity Type:Individual
Prefix:MRS
First Name:AI-LAN
Middle Name:
Last Name:WHITSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 CENTER ST NE RM 2360
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4532
Mailing Address - Country:US
Mailing Address - Phone:503-361-2609
Mailing Address - Fax:503-566-2971
Practice Address - Street 1:3180 CENTER ST NE RM 2360
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4532
Practice Address - Country:US
Practice Address - Phone:503-361-2609
Practice Address - Fax:503-566-2971
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1335133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered