Healthcare Provider Details

I. General information

NPI: 1497581045
Provider Name (Legal Business Name): DIANE ELIZABETH MEEHAN RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13905 SW MERIDIAN ST UNIT 409
BEAVERTON OR
97005-2475
US

IV. Provider business mailing address

13905 SW MERIDIAN ST UNIT 409
BEAVERTON OR
97005-2475
US

V. Phone/Fax

Practice location:
  • Phone: 917-763-6000
  • Fax:
Mailing address:
  • Phone: 917-763-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-D-10166688
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: