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General NPI Number Information
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NPI Number | 1457982480
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Entity Type | Organization
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Legal Business Name | DAMZIL NUTRITION COUNSELING, LLC
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Dates
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Enumeration Date | 01/29/2020
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 3795 RIVER RD N STE D
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City | KEIZER
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State | OR
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Zip | 97303-4826
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Country | US
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Telephone | 503-457-4923
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Fax | 503-376-6714
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Provider Business Mailing Address
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Address Line | PO BOX 284
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City | HUBBARD
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State | OR
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Zip | 97032-0284
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Country | US
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Telephone | 503-457-4923
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Fax | 503-376-6714
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Authorized Official
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Title or Position | OWNER
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Name | LIZETTE M DUBAY COURTNEY
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Credential | RDN
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Telephone | 503-457-4923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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