Healthcare Provider Details

I. General information

NPI: 1447834288
Provider Name (Legal Business Name): REGAN PETERSON, RD, LD, NUTRITION CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 E 5TH AVE STE 324
EUGENE OR
97401-2771
US

IV. Provider business mailing address

PO BOX 10222
EUGENE OR
97440-2222
US

V. Phone/Fax

Practice location:
  • Phone: 541-556-5646
  • Fax: 440-556-5642
Mailing address:
  • Phone: 541-556-5646
  • 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: REGAN PETERSON
Title or Position: OWNER
Credential: RD
Phone: 541-556-5646