Healthcare Provider Details

I. General information

NPI: 1871907519
Provider Name (Legal Business Name): ANNE B CORLEY MS, RD, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5282 SUGARPINE CIR
EUGENE OR
97402-1044
US

IV. Provider business mailing address

5282 SUGARPINE CIR
EUGENE OR
97402-1044
US

V. Phone/Fax

Practice location:
  • Phone: 253-301-5280
  • Fax:
Mailing address:
  • Phone: 253-820-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI00001216
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: