=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619157898
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RANDEE JEAN ANSHUTZ RDN, LD, LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2007
-----------------------------------------------------
Last Update Date | 11/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 369 NE REVERE AVE STE 105
-----------------------------------------------------
City | BEND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97701-4082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-323-3488
-----------------------------------------------------
Fax | 541-323-3483
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 369 NE REVERE AVE STE 105
-----------------------------------------------------
City | BEND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97701-4082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-323-3488
-----------------------------------------------------
Fax | 541-323-3483
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 295547-00
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 01030191
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 7602
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------