Provider Demographics
NPI:1245129089
Name:HANDLEY, BERNADETTE M (LD, RD)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:M
Last Name:HANDLEY
Suffix:
Gender:F
Credentials:LD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 SW CENTURY DRIVE STE 100
Mailing Address - Street 2:PMB 136
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3558
Mailing Address - Country:US
Mailing Address - Phone:541-420-7560
Mailing Address - Fax:
Practice Address - Street 1:18575 SW CENTURY DR # 413
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1950
Practice Address - Country:US
Practice Address - Phone:541-420-7560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-28
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10257149133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered