Provider Demographics
NPI:1942507918
Name:GUTHRIE MEDLEN, JOAN E (RD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:E
Last Name:GUTHRIE MEDLEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3638 SW VESTA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7564
Mailing Address - Country:US
Mailing Address - Phone:971-645-4722
Mailing Address - Fax:503-446-6053
Practice Address - Street 1:3638 SW VESTA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-7564
Practice Address - Country:US
Practice Address - Phone:971-645-4722
Practice Address - Fax:503-446-6053
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-27
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR709397133V00000X
OR520133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered