Provider Demographics
NPI:1124765417
Name:MCNAB, ERIN NICOLE (RD, LD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:NICOLE
Last Name:MCNAB
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 1:1685 SE UMATILLA ST APT 405
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7242
Mailing Address - Country:US
Mailing Address - Phone:503-508-9119
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:971-350-9734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10202446133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered