Healthcare Provider Details

I. General information

NPI: 1306289079
Provider Name (Legal Business Name): KIMBERLY ARLENE KAUZER MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 N GANTENBEIN AVE
PORTLAND OR
97227-1623
US

IV. Provider business mailing address

2801 N GANTENBEIN AVE
PORTLAND OR
97227-1623
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-2986
  • Fax: 503-413-2190
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberLD-D-000945
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: