Individual
MRS. JILLIAN DARCY BLISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
5211 NE GLISAN ST BLDG C, PORTLAND, OR 97213
(503) 215-6628
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD-D-000877
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500734039
—
OR
Enumeration date
06/30/2015
Last updated
08/19/2018
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