Provider Demographics
NPI:1285301283
Name:DIANA, EMILY FLYNN (MS, RD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:FLYNN
Last Name:DIANA
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 E BURNSIDE ST APT 127
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1797
Mailing Address - Country:US
Mailing Address - Phone:602-540-2462
Mailing Address - Fax:
Practice Address - Street 1:2625 E BURNSIDE ST APT 326
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1875
Practice Address - Country:US
Practice Address - Phone:602-540-2462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR86167626133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered