Provider Demographics
NPI:1669799367
Name:RAYMOND, MARCI MICHELLE (RDN)
Entity type:Individual
Prefix:MRS
First Name:MARCI
Middle Name:MICHELLE
Last Name:RAYMOND
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 1:2825 E BARNETT
Mailing Address - Street 2:RRMC MSS
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-789-4281
Mailing Address - Fax:541-789-4806
Practice Address - Street 1:700 SW RAMSEY AVE STE 101
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5788
Practice Address - Country:US
Practice Address - Phone:541-789-5906
Practice Address - Fax:541-789-7123
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10203735133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR165772Medicaid