Healthcare Provider Details

I. General information

NPI: 1659435469
Provider Name (Legal Business Name): CATHERINE ZUCK MILLER MPH, RD, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 E MCANDREWS RD SUITE 170
MEDFORD OR
97504-5589
US

IV. Provider business mailing address

PO BOX 3158
PORTLAND OR
97208-3158
US

V. Phone/Fax

Practice location:
  • Phone: 541-732-6957
  • Fax: 541-732-7901
Mailing address:
  • Phone: 541-732-6957
  • Fax: 541-732-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number344
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: