Provider Demographics
NPI:1881212272
Name:RYDER, EMILY (RDN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:RYDER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 NW 20TH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1219
Mailing Address - Country:US
Mailing Address - Phone:781-635-6346
Mailing Address - Fax:
Practice Address - Street 1:624 NW 20TH AVE APT 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1219
Practice Address - Country:US
Practice Address - Phone:781-635-6346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-11
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered