Healthcare Provider Details

I. General information

NPI: 1619184173
Provider Name (Legal Business Name): DEBORAH A HAMPTON RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 SW 9TH ST SAINT ALPHONSUS MEDICAL CENTER-ONTARIO
ONTARIO OR
97914-2639
US

IV. Provider business mailing address

3340 E GOLDSTONE WAY
MERIDIAN ID
83642-1026
US

V. Phone/Fax

Practice location:
  • Phone: 541-881-7480
  • Fax: 541-881-7147
Mailing address:
  • Phone: 208-367-5170
  • Fax: 208-367-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberOR663
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD-294
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-D-000663
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: