Provider Demographics
NPI:1912744533
Name:POWELL, TAMBERLY (MS, RDN)
Entity type:Individual
Prefix:
First Name:TAMBERLY
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 RIVER AVE UNIT 40204
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-0801
Mailing Address - Country:US
Mailing Address - Phone:541-554-2196
Mailing Address - Fax:
Practice Address - Street 1:207 E 5TH AVE STE 220
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2774
Practice Address - Country:US
Practice Address - Phone:541-554-2196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10242945133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered