Healthcare Provider Details

I. General information

NPI: 1740764315
Provider Name (Legal Business Name): NATALIE ANNE SCANDURRO MS, RD, CSP, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE ANNE DAMEN MS, RD, CSP, LD

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19185 SW 90TH AVE
TUALATIN OR
97062-7558
US

IV. Provider business mailing address

7510 SE MILWAUKIE AVE APT 209
PORTLAND OR
97202-6113
US

V. Phone/Fax

Practice location:
  • Phone: 503-813-2000
  • Fax:
Mailing address:
  • Phone: 206-450-5876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number10193327
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: