Organization
FEARLESS WITH FOOD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TESSA KOMINE MS, RDN, LD, CD (OWNER)
(971) 270-0590
Entity
Organization
Contact information
Practice address
2100 NE BROADWAY ST STE 225, PORTLAND, OR 97232-1544
(971) 270-0590
(971) 255-1754
Mailing address
2100 NE BROADWAY ST STE 225, PORTLAND, OR 97232-1544
(971) 270-0590
(971) 255-1754
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500742923
—
OR
Enumeration date
10/19/2019
Last updated
10/19/2019
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