Healthcare Provider Details

I. General information

NPI: 1235161928
Provider Name (Legal Business Name): LYNNE OLDHAM PHD, RD, CDE, CHES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2036 NE WILLIAMSON CT
BEND OR
97701-3771
US

IV. Provider business mailing address

2676 NW PICKETT CT
BEND OR
97701-6807
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-6348
  • Fax:
Mailing address:
  • Phone: 541-598-4179
  • Fax: 541-388-9261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number653
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: