Provider Demographics
NPI:1801106935
Name:CONNER, VALERIE MARGARET (MS RD CDE)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:MARGARET
Last Name:CONNER
Suffix:
Gender:F
Credentials:MS RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8982 SW HERB WAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2243
Mailing Address - Country:US
Mailing Address - Phone:503-453-7193
Mailing Address - Fax:
Practice Address - Street 1:8982 SW HERB WAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-2243
Practice Address - Country:US
Practice Address - Phone:503-453-7193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR400133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered