Organization
CHERRY CITY NUTRITION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA ELIZABETH SHORT RD (SOLE PROPRIETOR)
(971) 273-8668
Entity
Organization
Contact information
Practice address
780 COMMERCIAL ST SE STE 305, SALEM, OR 97301-3455
(971) 273-8668
Mailing address
5113 CHERRY HOLLOW LN S, SALEM, OR 97302-9634
(971) 273-8668
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD-D-10144657
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
962738
COMMISSION ON DIETETIC REGISTRATION
—
01
—
LD-D-10144657
STATE OF OREGON
OR
Enumeration date
08/15/2018
Last updated
08/15/2018
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