Provider Demographics
NPI:1962237537
Name:STEVENS, CHARLENE MARIE (RDN, RD)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MARIE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:RDN, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 UMATILLA ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-1744
Mailing Address - Country:US
Mailing Address - Phone:208-301-8777
Mailing Address - Fax:
Practice Address - Street 1:2708 UMATILLA ST
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1744
Practice Address - Country:US
Practice Address - Phone:208-301-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered