Provider Demographics
NPI:1427632884
Name:GI NUTRITION NW, LLC
Entity type:Organization
Organization Name:GI NUTRITION NW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATNODE
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:971-238-2369
Mailing Address - Street 1:2175 NW RALEIGH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2392
Mailing Address - Country:US
Mailing Address - Phone:503-319-8449
Mailing Address - Fax:
Practice Address - Street 1:2175 NW RALEIGH ST STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2392
Practice Address - Country:US
Practice Address - Phone:971-238-2369
Practice Address - Fax:971-277-5491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty