Healthcare Provider Details

I. General information

NPI: 1316676323
Provider Name (Legal Business Name): JANA SKOOG MS, RD, CSOWM, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 CHAD DR
EUGENE OR
97408-7428
US

IV. Provider business mailing address

3365 TWIN ELMS DR
EUGENE OR
97408-7543
US

V. Phone/Fax

Practice location:
  • Phone: 541-440-1000
  • Fax:
Mailing address:
  • Phone: 765-437-2643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberLD-D-001045
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: