Provider Demographics
NPI:1720167638
Name:NORDLUND, MARY ARAKELIAN (RD,CDE)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ARAKELIAN
Last Name:NORDLUND
Suffix:
Gender:F
Credentials:RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 SE 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-2424
Mailing Address - Country:US
Mailing Address - Phone:503-760-8429
Mailing Address - Fax:
Practice Address - Street 1:7201 N INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5523
Practice Address - Country:US
Practice Address - Phone:503-286-6816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR394157133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education