Healthcare Provider Details

I. General information

NPI: 1538120621
Provider Name (Legal Business Name): PAULA F VOKOUN RD, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19300 SW 65TH AVE MERIDIAN PARK HOSPITAL DIABETES SERVICES
TUALATIN OR
97062-7706
US

IV. Provider business mailing address

1257 ROCKINGHORSE LN
LAKE OSWEGO OR
97034-1657
US

V. Phone/Fax

Practice location:
  • Phone: 503-692-7617
  • Fax: 503-692-7788
Mailing address:
  • Phone: 503-692-7617
  • Fax: 503-692-7788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number249
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: