Healthcare Provider Details

I. General information

NPI: 1164748000
Provider Name (Legal Business Name): LYNAE ADRIEN SMITH R.D., LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 W 17TH AVE
EUGENE OR
97401-3816
US

IV. Provider business mailing address

581 W 17TH AVE
EUGENE OR
97401-3816
US

V. Phone/Fax

Practice location:
  • Phone: 541-497-3885
  • Fax: 844-517-6506
Mailing address:
  • Phone: 541-497-3885
  • Fax: 844-517-6506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-D-000872
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: