1437305315 NPI number — ILEANA KARMIE LEE RDN, LDN, CDCES

Table of content: ILEANA KARMIE LEE RDN, LDN, CDCES (NPI 1437305315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437305315 NPI number — ILEANA KARMIE LEE RDN, LDN, CDCES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
ILEANA
Provider Middle Name:
KARMIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDN, LDN, CDCES
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437305315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3550 N INTERSTATE AVENUE
Provider Second Line Business Mailing Address:
INTERSTATE MEDICAL OFFICE EAST, NUTRITION DEPARTMENT
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97227-1097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-249-6705
Provider Business Mailing Address Fax Number:
503-331-6319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9800 SE SUNNYSIDE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLACKAMAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97015-9750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-571-3040
Provider Business Practice Location Address Fax Number:
503-570-3418
Provider Enumeration Date:
08/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  724 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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