Provider Demographics
NPI:1467852707
Name:NEWMARK, GRETCHEN (RD, MA)
Entity type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:
Last Name:NEWMARK
Suffix:
Gender:F
Credentials:RD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 NE 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1218
Mailing Address - Country:US
Mailing Address - Phone:503-249-8064
Mailing Address - Fax:
Practice Address - Street 1:2525 NE 44TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1218
Practice Address - Country:US
Practice Address - Phone:503-249-8064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000110133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered