Provider Demographics
NPI:1447834288
Name:REGAN PETERSON, RD, LD, NUTRITION CONSULTING, LLC
Entity type:Organization
Organization Name:REGAN PETERSON, RD, LD, NUTRITION CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:541-556-5646
Mailing Address - Street 1:PO BOX 10222
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-2222
Mailing Address - Country:US
Mailing Address - Phone:541-556-5646
Mailing Address - Fax:
Practice Address - Street 1:296 E 5TH AVE STE 324
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2771
Practice Address - Country:US
Practice Address - Phone:541-556-5646
Practice Address - Fax:440-556-5642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty