Provider Demographics
NPI:1699385674
Name:DEAN, LAURA MACMASTER (RDN, CLT, IFNCP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MACMASTER
Last Name:DEAN
Suffix:
Gender:F
Credentials:RDN, CLT, IFNCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8935 SE POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1938
Mailing Address - Country:US
Mailing Address - Phone:503-772-4335
Mailing Address - Fax:
Practice Address - Street 1:8935 SE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1938
Practice Address - Country:US
Practice Address - Phone:503-772-4335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD-10223197133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered