Individual
MAKENNA STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
10180 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(971) 279-0963
Mailing address
PO BOX 401, CORBETT, OR 97019-0401
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
10217202
OR
Other
Enumeration date
12/08/2021
Last updated
03/07/2022
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