Healthcare Provider Details

I. General information

NPI: 1407581549
Provider Name (Legal Business Name): NOELLE FEIN MS,RDN,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23335 SE STARK ST
GRESHAM OR
97030-2923
US

IV. Provider business mailing address

14100 REDWOOD CT
LAKE OSWEGO OR
97034-2153
US

V. Phone/Fax

Practice location:
  • Phone: 503-465-0424
  • Fax:
Mailing address:
  • Phone: 503-504-9264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000665
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier881233
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerCOMMISSION ON DIETITIAN REGISTRATION

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: