Provider Demographics
NPI:1124215389
Name:PETERSON, REGAN (RD, LD)
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:440-556-5646
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR830133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered