Healthcare Provider Details

I. General information

NPI: 1467487173
Provider Name (Legal Business Name): LAURIE PARSIO RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 NW GARDEN VALLEY BLVD #140
ROSEBURG OR
97470-6523
US

IV. Provider business mailing address

599 HORIZON LN
MYRTLE CREEK OR
97457-9755
US

V. Phone/Fax

Practice location:
  • Phone: 541-440-1000
  • Fax: 541-440-1367
Mailing address:
  • Phone: 541-440-1000
  • Fax: 541-440-1367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number387174
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: