Provider Demographics
NPI:1659435469
Name:MILLER, CATHERINE ZUCK (MPH, RD, LD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:ZUCK
Last Name:MILLER
Suffix:
Gender:F
Credentials:MPH, RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:541-732-6957
Mailing Address - Fax:541-732-7901
Practice Address - Street 1:1698 E MCANDREWS RD
Practice Address - Street 2:SUITE 170
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5589
Practice Address - Country:US
Practice Address - Phone:541-732-6957
Practice Address - Fax:541-732-7901
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR344133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR344OtherOREGON LICENSE
OR299946Medicaid
OR344OtherOREGON LICENSE