Provider Demographics
NPI:1619157898
Name:ANSHUTZ, RANDEE JEAN (RDN, LD, LMT)
Entity Type:Individual
Prefix:
First Name:RANDEE
Middle Name:JEAN
Last Name:ANSHUTZ
Suffix:
Gender:F
Credentials:RDN, LD, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 NE FRANKLIN AVE
Mailing Address - Street 2:BUILDING C
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4917
Mailing Address - Country:US
Mailing Address - Phone:541-323-3488
Mailing Address - Fax:541-323-3483
Practice Address - Street 1:361 NE FRANKLIN AVE BLDG C
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4917
Practice Address - Country:US
Practice Address - Phone:541-323-3488
Practice Address - Fax:541-323-3483
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7602225700000X
295547-00225700000X
01030191133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist