Healthcare Provider Details

I. General information

NPI: 1063076537
Provider Name (Legal Business Name): CHERYL TESCHNER LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N SANTIAM HWY
LEBANON OR
97355-4363
US

IV. Provider business mailing address

525 N SANTIAM HWY
LEBANON OR
97355-4363
US

V. Phone/Fax

Practice location:
  • Phone: 541-258-2101
  • Fax: 541-451-7862
Mailing address:
  • Phone: 541-258-2101
  • Fax: 541-451-7862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD10176203
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: