Individual
MIRANDA R PETRONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RDN, LDN
Contact information
Practice address
4805 NE GLISAN ST STE 6N40, PORTLAND, OR 97213-2933
(503) 215-7230
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
L005959
NC
133V00000X
Registered Dietitian
Primary
LD-D-10215688
OR
Other
Enumeration date
10/14/2019
Last updated
06/09/2023
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