MEDICARE: MS. GRETCHEN NEWMARK R.D., M.A.

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
1	133V00000X	Registered Dietitian	000110	OR

General Provider Information

NPI Number	:	1467852707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GRETCHEN NEWMARK R.D., M.A.

Provider Business Mailing Address
First Line	:	2525 NE 44TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-1218
Country	:	US
Telephone Number	:	503-249-8064
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 NE 44TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-1218
Country	:	US
Telephone Number	:	503-249-8064
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2014
Last Update Date	:	08/22/2014

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