Individual
MRS. STEPHANIE CHERIE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CD
Contact information
Practice address
9701 SW BARNES RD STE 300, PORTLAND, OR 97225-6689
(503) 297-8081
(503) 292-6601
Mailing address
541 NE 20TH AVE STE 225, PORTLAND, OR 97232-2895
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
DI60691376
WA
133V00000X
Registered Dietitian
Primary
LD-D-10195500
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2121927
—
WA
05
—
500759809
—
OR
01
—
QMP000004581655
MOLINA
WA
Enumeration date
10/19/2016
Last updated
11/04/2024
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