Organization
MP NUTRITION THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAIA PENCHANSKY RDN LDN (OWNER, REGISTERED DIETITIAN)
(503) 983-7446
Entity
Organization
Contact information
Practice address
189 LIBERTY ST NE STE 210C, SALEM, OR 97301-3682
(503) 983-7446
(503) 483-2546
Mailing address
189 LIBERTY ST NE STE 210C, SALEM, OR 97301-3682
(503) 983-7446
(503) 483-2546
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500754422
—
OR
Enumeration date
08/20/2020
Last updated
04/06/2022
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