Provider Demographics
NPI:1619534039
Name:MERSINGER, KATIE (RDN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:MERSINGER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29317 SW TAMI LOOP APT 169
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-6526
Mailing Address - Country:US
Mailing Address - Phone:618-402-7412
Mailing Address - Fax:
Practice Address - Street 1:1750 MCGILCHRIST ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1691
Practice Address - Country:US
Practice Address - Phone:360-905-1745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1072772OtherCOMMISSION ON DIETETIC REGISTRATION