Healthcare Provider Details

I. General information

NPI: 1457982480
Provider Name (Legal Business Name): DAMZIL NUTRITION COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3795 RIVER RD N STE D
KEIZER OR
97303-4826
US

IV. Provider business mailing address

PO BOX 284
HUBBARD OR
97032-0284
US

V. Phone/Fax

Practice location:
  • Phone: 503-457-4923
  • Fax: 503-376-6714
Mailing address:
  • Phone: 503-457-4923
  • Fax: 503-376-6714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: LIZETTE M DUBAY COURTNEY
Title or Position: OWNER
Credential: RDN
Phone: 503-457-4923