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6542 Se Lake Rd Ste 202c, Milwaukie, OR 97222-2244 | |
| (503) 652-5070 | |
| (800) 957-1067 |
| Full Name | |
|---|---|
| Type | Facility |
| Speciality | Dietitian, Registered |
| Location | 6542 Se Lake Rd Ste 202c, Milwaukie, Oregon |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275604399 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 133V00000X | Dietitian, Registered | (* (Not Available)) | Primary |
| 174H00000X | Health Educator | (* (Not Available)) | Secondary |
| Provider Name | John Ellis Gobble |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1013919323 PECOS PAC ID: 2769577618 Enrollment ID: I20110331000071 |
| Provider Name | Rise Rafferty |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1912364662 PECOS PAC ID: 6608172093 Enrollment ID: I20160310002096 |
| Provider Name | Kendra Vos Becker |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1639702954 PECOS PAC ID: 6406285097 Enrollment ID: I20200402001409 |
| Provider Name | Judy A. Sundquist |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1538461603 PECOS PAC ID: 9133507551 Enrollment ID: I20220525002463 |
| Mailing Address | Practice Location Address |
|---|---|
1463 Sw 20th Ct, Gresham, OR 97080-9662 Ph: (503) 652-5070 | 6542 Se Lake Rd Ste 202c, Milwaukie, OR 97222-2244 Ph: (503) 652-5070 |
Anna Gianpetro, RDN, LD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 3482 Se Harvey St, Milwaukie, OR 97222 Phone: 480-961-2911 | |
Eeva S Gray, RD, CDE Dietitian Medicare: Not Enrolled in Medicare Practice Location: 6902 Se Lake Rd, Suite 100, Milwaukie, OR 97267 Phone: 503-786-1149 Fax: 503-786-1170 | |
Raquel Rose, R.D.N. Dietitian Medicare: Medicare Enrolled Practice Location: 2029 Se Jefferson St Ste 103, Milwaukie, OR 97222 Phone: 503-825-0075 | |
Lois Amy Tobin, RD,CSR,LD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 6902 Se Lake Rd, Suite 302, Milwaukie, OR 97267 Phone: 503-786-1148 Fax: 503-786-1170 | |
Northwest Primary Care Group, Pc Dietitian Medicare: Not Enrolled in Medicare Practice Location: 12300 Se Mallard Way, Suite 160, Milwaukie, OR 97222 Phone: 503-659-4777 Fax: 503-652-5223 | |
Nancy Frazeur, RD LD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 10150 Se 32nd Ave, Milwaukie, OR 97222 Phone: 503-513-8300 |