MEDICARE: KRISTA S SCHAEFER MS RDN LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	133V00000X	Registered Dietitian	LD-D-10206136	OR

General Provider Information

NPI Number	:	1033392618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA S SCHAEFER MS RDN LD

Provider Business Mailing Address
First Line	:	619 MADISON ST STE 102
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-2354
Country	:	US
Telephone Number	:	503-313-6461
Fax Number	:	503-650-7002

Provider Business Practice Location Address
First Line	:	619 MADISON ST STE 102
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-2354
Country	:	US
Telephone Number	:	503-313-6461
Fax Number	:	503-650-7002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2007
Last Update Date	:	01/24/2020

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