Individual
MR. JONATHAN WYMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD, LD
Contact information
Practice address
620 ELM ST SW # 2, ALBANY, OR 97321-1986
(541) 812-4839
Mailing address
620 ELM ST SW # 2, ALBANY, OR 97321-1986
(541) 812-4839
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LDD10175002
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86065504
COMMISION ON DIETETIC REGISTRATION
—
01
—
LDD10175002
OREGON DIETETIC LICENSURE
OR
Enumeration date
11/08/2016
Last updated
11/08/2016
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