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Individual

MS. JEANA BARBARA VAN DYKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RD, LD, CDE

Contact information

Practice address
631 ELM ST SW, SUITE 202, ALBANY, OR 97321-1952
(541) 812-4844
(541) 812-4849
Mailing address
1046 6TH AVE SW, ALBANY, OR 97321-1916
(541) 812-4000
(541) 812-4145

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
000503
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500639570
OR
Enumeration date
11/01/2006
Last updated
12/20/2017
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