Basic Information
| Provider Information | |||||||||
| NPI: | 1750596375 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOERSCHELL | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | R.D., L.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3028 NW CRAFTSMAN DRIVE | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413828451 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 NE NEFF ROAD | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413824321 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 000538 | OR | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.