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General NPI Number Information
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NPI Number | 1972680726
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Entity Type | Individual
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Provider Name | JEANA BARBARA VAN DYKE RD, LD, CDE
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 12/20/2017
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Provider Practice Location Address
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Address Line | 631 ELM ST SW SUITE 202
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City | ALBANY
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State | OR
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Zip | 97321-1952
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Country | US
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Telephone | 541-812-4844
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Fax | 541-812-4849
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Provider Business Mailing Address
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Address Line | 1046 6TH AVE SW
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City | ALBANY
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State | OR
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Zip | 97321-1916
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Country | US
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Telephone | 541-812-4000
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Fax | 541-812-4145
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 000503
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License Number State | OR
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