Healthcare Provider Details

I. General information

NPI: 1255742540
Provider Name (Legal Business Name): DANIELLE MARIE TOEPFER RD,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE MARIE KOECKRITZ RD, LD

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 N GANTENBEIN AVE
PORTLAND OR
97227-1530
US

IV. Provider business mailing address

1935 N WILLAMETTE BLVD
PORTLAND OR
97217-4418
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-2000
  • Fax:
Mailing address:
  • Phone: 708-269-8618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-D-000954
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: