Healthcare Provider Details

I. General information

NPI: 1396350229
Provider Name (Legal Business Name): CHELSEA ELIZABETH HORVATH RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 SE PALMQUIST RD APT 153
GRESHAM OR
97080-5276
US

IV. Provider business mailing address

2831 SE PALMQUIST RD APT 153
GRESHAM OR
97080-5276
US

V. Phone/Fax

Practice location:
  • Phone: 484-274-5739
  • Fax:
Mailing address:
  • Phone: 484-274-5739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-D-10209419
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: