Provider Demographics
NPI:1356594865
Name:LEE, ADRIENNE CLAIRE (RDN)
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:CLAIRE
Last Name:LEE
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:CLAIRE
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:369 NE REVERE AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4082
Mailing Address - Country:US
Mailing Address - Phone:541-323-3488
Mailing Address - Fax:541-323-3483
Practice Address - Street 1:369 NE REVERE AVE STE 105
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4082
Practice Address - Country:US
Practice Address - Phone:541-323-3488
Practice Address - Fax:541-323-3483
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10251614133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered