Healthcare Provider Details

I. General information

NPI: 1831231059
Provider Name (Legal Business Name): SHANNON MARIE RENTZ RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OREGON HEALTH & SCIENCES UNIVERSITY, MAIL CODE UHS 18 3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3098
US

IV. Provider business mailing address

2333 SE CLEVELAND AVE
GRESHAM OR
97080-6380
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-8636
  • Fax: 503-494-3769
Mailing address:
  • Phone: 503-494-8636
  • Fax: 503-494-3769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number579
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: