Provider Demographics
NPI:1285258004
Name:LANMAN, JON RICKY (RD, CEP)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:RICKY
Last Name:LANMAN
Suffix:
Gender:M
Credentials:RD, CEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 NE TRADITIONS CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6744
Mailing Address - Country:US
Mailing Address - Phone:509-598-6894
Mailing Address - Fax:
Practice Address - Street 1:2050 NE TRADITIONS CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6744
Practice Address - Country:US
Practice Address - Phone:509-598-6894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU61066518133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered