Provider Demographics
NPI:1629254628
Name:RADKE, MEREDITH A (RD)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:A
Last Name:RADKE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:MEREDITH
Other - Middle Name:ANN
Other - Last Name:NORBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:5627 SE 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-5411
Mailing Address - Country:US
Mailing Address - Phone:360-514-4268
Mailing Address - Fax:360-514-3590
Practice Address - Street 1:400 NE MOTHER JOSEPH PL
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3200
Practice Address - Country:US
Practice Address - Phone:360-514-4268
Practice Address - Fax:360-514-3590
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001776133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered