Provider Demographics
NPI:1306904446
Name:CEDAR, DENISE R (RD, CDE)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:R
Last Name:CEDAR
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 FAIRVIEW ST
Mailing Address - Street 2:SILVERTON HOSPITAL--PHELPS ANNEX
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1917
Mailing Address - Country:US
Mailing Address - Phone:503-873-1560
Mailing Address - Fax:503-874-2483
Practice Address - Street 1:342 FAIRVIEW ST
Practice Address - Street 2:SILVERTON HOSPITAL--PHELPS ANNEX
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1917
Practice Address - Country:US
Practice Address - Phone:503-873-1560
Practice Address - Fax:503-874-2483
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR170133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR711758OtherREGISTERED DIETITIAN REGISTRATION NUMBER
OR170OtherOREGON LICENSED DIETITIAN
OR711758OtherRD REGISTRATION NUMBER
OR112574Medicare PIN