Individual
MS. BONNIE CAVANAGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
3517 NW SAMARITAN DRIVE, SUITE 100, CORVALLIS, OR 97330-3768
(541) 768-4280
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD-D-10160158
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1078859
COMMISSION ON DIETETIC REGISTRATION
OR
01
—
LD-D-10160158
OREGON HEALTH LICENSING
OR
Enumeration date
12/18/2013
Last updated
05/24/2022
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