Healthcare Provider Details

I. General information

NPI: 1144827528
Provider Name (Legal Business Name): CREATING NUTRITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2714 MADISON STREET
EUGENE OR
97405-8200
US

IV. Provider business mailing address

2852 WILLAMETTE STREET STE 359
EUGENE OR
97405-8200
US

V. Phone/Fax

Practice location:
  • Phone: 541-243-3665
  • Fax: 541-224-5277
Mailing address:
  • Phone: 541-243-3665
  • Fax: 541-224-5277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: COLIN MACDONALD
Title or Position: CO-OWNER
Credential:
Phone: 541-243-3665