Provider Demographics
NPI:1952730384
Name:ABBOTT, DENISE (RD, LD, RN)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:RD, LD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 SUZANNE WAY
Mailing Address - Street 2:STE 200
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7319
Mailing Address - Country:US
Mailing Address - Phone:541-228-3008
Mailing Address - Fax:541-228-3180
Practice Address - Street 1:2650 SUZANNE WAY
Practice Address - Street 2:STE 200
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7319
Practice Address - Country:US
Practice Address - Phone:541-228-3008
Practice Address - Fax:541-228-3180
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10159102133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered