Healthcare Provider Details

I. General information

NPI: 1154403442
Provider Name (Legal Business Name): CYNTHIA JAN COLE R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 6TH AVE SW SAMARITAN ALBANY GENERAL HOSPITAL
ALBANY OR
97321-1916
US

IV. Provider business mailing address

2110 NW MYRTLEWOOD WAY
CORVALLIS OR
97330-1062
US

V. Phone/Fax

Practice location:
  • Phone: 541-812-4843
  • Fax:
Mailing address:
  • Phone: 541-753-6713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number551
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: