Amanda Kristine Fredrickson, R.D.
Dietitian, Registered in Portland, OR. Individual provider (NPI-1).
NPI number1346852365
StatusActive
Last updated in NPPESAug 20, 2020
Details
- NPI
- 1346852365
- Entity type
- Individual (NPI-1)
- Name
- Amanda Kristine Fredrickson
- Credential
- R.D.
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 20, 2020
- Certification date
- Aug 20, 2020
- Last updated
- Aug 20, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 133V00000X | Dietitian, Registered | – | – | Yes |
Practice location
3611 Se 64th Ave.Portland, OR 97206
Phone 503-494-8300
Mailing address
3611 Se 64th Ave.Portland, OR 97206
Phone 503-494-8300
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