Provider Demographics
NPI:1861845331
Name:LIVINGSTON, HEIDI KAT (LRDN)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:KAT
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:LRDN
Other - Prefix:MRS
Other - First Name:HEIDI
Other - Middle Name:KATRINE
Other - Last Name:THOMASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LRDN
Mailing Address - Street 1:2400 E HAWORTH AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1392
Mailing Address - Country:US
Mailing Address - Phone:503-890-9822
Mailing Address - Fax:866-491-2808
Practice Address - Street 1:200 NE NORTON LN
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8470
Practice Address - Country:US
Practice Address - Phone:503-435-0597
Practice Address - Fax:503-435-0862
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR312950133V00000X, 133VN1201X, 133V00000X
86011974133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR312950OtherOREGON HEALTH LICENSING, BOARD OF LICENSED DIETITIANS
86011974OtherCOMMISSION ON DIETETIC REGISTRATION