Healthcare Provider Details

I. General information

NPI: 1669799367
Provider Name (Legal Business Name): MARCI MICHELLE RAYMOND RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SW RAMSEY AVE STE 101
GRANTS PASS OR
97527-5788
US

IV. Provider business mailing address

2825 E BARNETT RRMC MSS
MEDFORD OR
97504
US

V. Phone/Fax

Practice location:
  • Phone: 541-789-5906
  • Fax: 541-789-7123
Mailing address:
  • Phone: 541-789-4281
  • Fax: 541-789-4806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number10203735
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: