Provider Demographics
NPI:1538461603
Name:SUNDQUIST, JUDY A (MPH, RD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:A
Last Name:SUNDQUIST
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7928 NW ARBORETUM RD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9538
Mailing Address - Country:US
Mailing Address - Phone:541-207-3570
Mailing Address - Fax:541-207-3570
Practice Address - Street 1:7928 NW ARBORETUM ROAD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-9538
Practice Address - Country:US
Practice Address - Phone:541-207-3570
Practice Address - Fax:541-207-3570
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00413617133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered