Provider Demographics
NPI:1457889057
Name:LUNDY, WHITNEY (MS RDN LD)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:LUNDY
Suffix:
Gender:F
Credentials:MS RDN LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 MUIRFIELD CT SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-8598
Mailing Address - Country:US
Mailing Address - Phone:503-551-4072
Mailing Address - Fax:
Practice Address - Street 1:780 COMMERCIAL ST SE STE 305
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-551-4072
Practice Address - Fax:971-273-0542
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10183927133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered