Healthcare Provider Details

I. General information

NPI: 1508901976
Provider Name (Legal Business Name): CARRIE JEAN ROBINSON-LOUGHRAN RD,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MADISON AVE
ASTORIA OR
97103-5027
US

IV. Provider business mailing address

100 MADISON AVE
ASTORIA OR
97103-5027
US

V. Phone/Fax

Practice location:
  • Phone: 971-645-8377
  • Fax: 503-650-5063
Mailing address:
  • Phone: 971-645-8377
  • Fax: 503-650-5063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number404
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: