Provider Demographics
NPI:1427755602
Name:UNDERWOOD, DENISE (MSCN)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MSCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 SW YAMHILL ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2539
Mailing Address - Country:US
Mailing Address - Phone:503-222-1315
Mailing Address - Fax:
Practice Address - Street 1:1033 SW YAMHILL ST STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2539
Practice Address - Country:US
Practice Address - Phone:503-222-1315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist