Healthcare Provider Details

I. General information

NPI: 1215554209
Provider Name (Legal Business Name): JOSEPH ALBRECHT RDN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 NW GARDEN VALLEY BLVD
ROSEBURG OR
97471-6523
US

IV. Provider business mailing address

2756 NW EDENBOWER BLVD APT 14
ROSEBURG OR
97471-6257
US

V. Phone/Fax

Practice location:
  • Phone: 541-441-1000
  • Fax:
Mailing address:
  • Phone: 516-214-3602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86030401
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: