Individual
MRS. CONNIE KAY WARNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD
Contact information
Practice address
830 NE 47TH AVE, PORTLAND, OR 97213-2212
(503) 215-2255
Mailing address
830 NE 47TH AVE, PORTLAND, OR 97213-2212
(503) 215-2255
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
DI 00000873
WA
133V00000X
Registered Dietitian
Primary
LD-D-000647
OR
Other
Enumeration date
03/26/2013
Last updated
03/26/2013
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