Provider Demographics
NPI:1508038472
Name:SMITH, PATRICIA HARLING (RD, LD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:HARLING
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:HARLING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:21920 SW RIBERA LN
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-9127
Mailing Address - Country:US
Mailing Address - Phone:503-504-1095
Mailing Address - Fax:
Practice Address - Street 1:8716 E MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2531
Practice Address - Country:US
Practice Address - Phone:360-514-7937
Practice Address - Fax:360-514-4233
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001969133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered