Provider Demographics
NPI:1205152048
Name:HEDENGREN, JAN LOUISE (RD)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:LOUISE
Last Name:HEDENGREN
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 1:1001 PROVIDENCE DR
Mailing Address - Street 2:DIETARY DEPARTMENT
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-7485
Mailing Address - Country:US
Mailing Address - Phone:503-537-1536
Mailing Address - Fax:503-537-5616
Practice Address - Street 1:1001 PROVIDENCE DR
Practice Address - Street 2:DIETARY DEPARTMENT
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-7485
Practice Address - Country:US
Practice Address - Phone:503-537-1536
Practice Address - Fax:503-537-5616
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR715133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered