Individual
MRS. MOLLY JANE HAYNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
7201 N INTERSTATE AVE, PORTLAND, OR 97217-5523
(503) 286-6865
(503) 286-6881
Mailing address
2633 SE 67TH AVE, PORTLAND, OR 97206-1218
(503) 239-3863
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
548
OR
Other
Enumeration date
08/12/2008
Last updated
08/12/2008
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