Provider Demographics
NPI:1831388636
Name:LAMB, STACEY MARIE (RD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:MARIE
Last Name:LAMB
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:MARIE
Other - Last Name:LAVOIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 574
Mailing Address - Street 2:MAIL CODE: CDRC-F
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207-0574
Mailing Address - Country:US
Mailing Address - Phone:503-418-2213
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-418-2213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR841133VN1006X
AK234133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic