Healthcare Provider Details

I. General information

NPI: 1881785483
Provider Name (Legal Business Name): AMY MAE FRASIEUR MS RDN LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY MAE LORINCZ RD LD

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 SW MEMORIAL PL
CORVALLIS OR
97331-8667
US

IV. Provider business mailing address

108 SW MEMORIAL PL
CORVALLIS OR
97331-8667
US

V. Phone/Fax

Practice location:
  • Phone: 541-737-5041
  • Fax:
Mailing address:
  • Phone: 541-737-5041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: