Healthcare Provider Details

I. General information

NPI: 1528335809
Provider Name (Legal Business Name): LIZETTE MARIE DUBAY COURTNEY RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2011
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 NumberLD-D-001008
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: