Provider Demographics
NPI:1952958712
Name:MCKILLOP, CARLEEN DANA (RD)
Entity Type:Individual
Prefix:
First Name:CARLEEN
Middle Name:DANA
Last Name:MCKILLOP
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91150 TRIPLE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-9460
Mailing Address - Country:US
Mailing Address - Phone:541-514-4395
Mailing Address - Fax:
Practice Address - Street 1:296 E 5TH AVE STE 321
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2771
Practice Address - Country:US
Practice Address - Phone:541-337-3437
Practice Address - Fax:541-833-0675
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLDD10199312133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered