Individual
LUCY MARDEN WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2705 E BURNSIDE ST STE 206, PORTLAND, OR 97214-1768
(732) 963-6670
Mailing address
2705 E BURNSIDE ST STE 206, PORTLAND, OR 97214-1768
(732) 963-6670
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD-D-10230579
OR
Other
Enumeration date
02/25/2021
Last updated
10/10/2025
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