Provider Demographics
NPI:1801376405
Name:MCGUIRE, MAGGIE JEAN (RD)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:JEAN
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 NE 23RD AVE APT 24
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3802
Mailing Address - Country:US
Mailing Address - Phone:618-925-4480
Mailing Address - Fax:
Practice Address - Street 1:240 PHELPS ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1927
Practice Address - Country:US
Practice Address - Phone:503-873-1619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered