Provider Demographics
NPI:1679823108
Name:STRATEGIC NUTRITION
Entity Type:Organization
Organization Name:STRATEGIC NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:STREALY
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:503-974-6454
Mailing Address - Street 1:5021 TUALATA LN
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7116
Mailing Address - Country:US
Mailing Address - Phone:503-974-6454
Mailing Address - Fax:
Practice Address - Street 1:5021 TUALATA LN
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7116
Practice Address - Country:US
Practice Address - Phone:503-974-6454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-000446133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty