Provider Demographics
NPI:1740764315
Name:SCANDURRO, NATALIE ANNE (MS, RD, CSP, LD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANNE
Last Name:SCANDURRO
Suffix:
Gender:F
Credentials:MS, RD, CSP, LD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:ANNE
Other - Last Name:DAMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CSP, LD
Mailing Address - Street 1:7510 SE MILWAUKIE AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6113
Mailing Address - Country:US
Mailing Address - Phone:206-450-5876
Mailing Address - Fax:
Practice Address - Street 1:19185 SW 90TH AVE
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7558
Practice Address - Country:US
Practice Address - Phone:503-813-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10193327133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10193327OtherLICENSED DIETITIAN
86080950OtherREGISTERED DIETITIAN