Provider Demographics
NPI:1063711711
Name:GEDGAUDAS, NORA
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:
Last Name:GEDGAUDAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 NORTH WEST JOHNSON STREET
Mailing Address - Street 2:SUITE #123
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209
Mailing Address - Country:US
Mailing Address - Phone:503-274-7733
Mailing Address - Fax:503-274-7770
Practice Address - Street 1:1920 NW JOHNSON ST
Practice Address - Street 2:SUITE #123
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1325
Practice Address - Country:US
Practice Address - Phone:503-274-7733
Practice Address - Fax:503-274-7770
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000400133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR133N00000XOtherNUTRITIONIST