Provider Demographics
NPI:1831641950
Name:THE NAKED DIETITIAN
Entity Type:Organization
Organization Name:THE NAKED DIETITIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:DORANCE
Authorized Official - Last Name:ONEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MSCI, LD
Authorized Official - Phone:812-350-9833
Mailing Address - Street 1:3737 SE 36TH PL
Mailing Address - Street 2:UNIT 22
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1858
Mailing Address - Country:US
Mailing Address - Phone:812-350-9833
Mailing Address - Fax:
Practice Address - Street 1:3737 SE 36TH PL
Practice Address - Street 2:UNIT 22
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1858
Practice Address - Country:US
Practice Address - Phone:812-350-9833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10172220133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty