Provider Demographics
NPI:1942717780
Name:SCHULTZ, HEIDI ANN (RD, LD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANN
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 SW LANDING DR APT 101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-5968
Mailing Address - Country:US
Mailing Address - Phone:971-804-2278
Mailing Address - Fax:
Practice Address - Street 1:5050 SW LANDING DR APT 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-5968
Practice Address - Country:US
Practice Address - Phone:971-804-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1033193133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered