Healthcare Provider Details

I. General information

NPI: 1427205343
Provider Name (Legal Business Name): MOLLY SIEMENS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 NW VAUGHN ST STE 140
PORTLAND OR
97210-5344
US

IV. Provider business mailing address

19390 SW REGAL CT
BEAVERTON OR
97006-2806
US

V. Phone/Fax

Practice location:
  • Phone: 503-499-5147
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: