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NPI Code Detail

MEDICARE: EZGI ERTEMIN-PEARSON

MEDICARE: EZGI ERTEMIN-PEARSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianLD-D-10190125OR

General Provider Information

NPI Number : 1396242863
Entity Type Code : Individual
Provider Name (Legal Business Name) : EZGI ERTEMIN-PEARSON
Provider Business Mailing Address
First Line : 1775 THOMPSON RD
Second Line :
City : COOS BAY
State : OR
Zip : 97420-2198
Country : US
Telephone Number : 541-269-8111
Fax Number :
Provider Business Practice Location Address
First Line : 1775 THOMPSON RD
Second Line :
City : COOS BAY
State : OR
Zip : 97420-2198
Country : US
Telephone Number : 541-269-8111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2018
Last Update Date : 04/10/2018

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Directions to “ EZGI ERTEMIN-PEARSON ” Practice Location

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