MLB NUTRITION & WELLNESS, LLC (NPI# 1124397062) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124397062 |
| Entity Type | Organization |
| Organization Name | MLB NUTRITION & WELLNESS, LLC |
| Practice Address |
10101 Se Main St Portland OR 97216-2455 |
| Mailing Address |
5071 W Sunset Dr Lake Oswego OR 97035-4253 |
| Practice Telephone | 9176802820 |
| Mailing Telephone | 9176802820 |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2011-12-21 |
| Authorized Official Name | MS. MELISSA LYNN BOLLMAN (PRESIDENT) |
| Authorized Official Telephone | 9176802820 |
| Authorized Official Credential | M.S., R.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133VN1006X |
Dietitian, Registered Specialization: Nutrition, Metabolic |
LDD10144515 | OR | Dietary & Nutritional Service Providers |
| Street Address |
10101 SE MAIN ST |
| City | PORTLAND |
| State | OR |
| Zip Code | 97216-2455 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316940075 | John W. Griffin | Internal Medicine | 10101 Se Main St, Ste 2001, Portland, OR 97216-2457 | 2005-05-24 |
| 1407390206 | Ansley Hill | Dietitian, Registered | 10101 Se Main St, Suite 1001, Portland, OR 97216-2455 | 2016-12-13 |
| 1710420278 | Portland Adv Medical Center | General Acute Care Hospital | 10101 Se Main St, Suite 1001, Portland, OR 97216-2455 | 2016-11-30 |
| 1831647593 | David N Carothers Dds PC | Dentist | 10101 Se Main St, Suite 3009, Portland, OR 97216-2455 | 2016-09-12 |
| 1518388495 | Jessica Anne Richards | Dietitian, Registered | 10101 Se Main St, Suite 1001, Portland, OR 97216-2455 | 2013-12-19 |
| 1548558323 | Gregory Gullo, Md PC | Specialist | 10101 Se Main St, Suite 2014, Portland, OR 97216-2455 | 2011-07-14 |
| 1831482439 | Harpreet Kaur | Psychiatry & Neurology | 10101 Se Main St, Ste 1006, Portland, OR 97216-2456 | 2011-05-16 |
| 1356650949 | Arnold L Petersen II Md PC | Obstetrics & Gynecology | 10101 Se Main St, Suite 2011, Portland, OR 97216-2455 | 2010-09-29 |
| 1356573059 | Dulcinea Marie Ward | Dietitian, Registered | 10101 Se Main St, Suite 2014, Portland, OR 97216-2455 | 2009-08-13 |
| 1689812430 | Mt. Hood Imaging, LLC | Clinic/Center | 10101 Se Main St, Suite 2004, Portland, OR 97216-2455 | 2009-02-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316468341 | Accident Care Chiropractic and Massage of Salem | Clinic/Center | 2168 Lancaster Dr. Ne, Portland, OR 97216 | 2017-06-29 |
| 1528508520 | Damone Brown | Peer Specialist | 10209 Se Washington St, Suite D, Portland, OR 97216 | 2017-02-24 |
| 1861937237 | Malachai Investments LLC | Clinical Medical Laboratory | 10,000 Se Main St, Ste 360, Portland, OR 97216 | 2016-12-21 |
| 1881136836 | Krista Marie Darnell | Occupational Therapy Assistant | 1475, Se 100th Avenue, Portland, OR 97216 | 2016-11-08 |
| 1821456559 | Sean Kelly | Counselor | 10564 Se Washington Street, Portland, OR 97216 | 2016-02-09 |
| 1174908321 | Phil Bergland | Counselor | 11220 Se Stark St, Suite 6, Portland, OR 97216 | 2015-07-29 |
| 1134507346 | Beth Lopez | Massage Therapist | 5814 Se Stark Street, Portland, OR 97216 | 2015-05-08 |
| 1982081477 | Amelia C Hunt | Counselor | 10564 Se Washinton Street, Portland, OR 97216 | 2015-05-04 |
| 1073907978 | Karen Ta | Emergency Medicine | 10300 Se Main St, Portland, OR 97216 | 2015-03-27 |
| 1265823298 | Laura Catherine Anderson | Occupational Therapist | 1475 Se 100th Avenue, Portland, OR 97216 | 2015-02-12 |
| Find all providers in zip 97216 | ||||
| Taxonomy Code | 133VN1006X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| Specialization | Nutrition, Metabolic |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790832152 | Sandra Carol Vancalcar | Dietitian, Registered | 840 Sw Gaines St, Portland, OR 97239-2904 | 2007-01-05 |
| 1114453099 | Kindra L Thrasher | Dietitian, Registered | 10101 Se Main St Ste 2011, Portland, OR 97216-2457 | 2017-05-11 |
| 1831388636 | Stacey Marie Lamb | Dietitian, Registered | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2007-10-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093013161 | Holly Rae St.lawrence | Dietitian, Registered | 566 Horn Ln, Eugene, OR 97404-2961 | 2011-03-14 |
| 1326362856 | Kiah Suzanne Sanger | Dietitian, Registered | 8495 Crater Lake Hwy, Bld 211 Un Rm 217, White City, OR 97503-3011 | 2010-03-26 |
| 1508901976 | Carrie Jean Robinson-loughran | Dietitian, Registered | 100 Madison Ave, Astoria, OR 97103-5027 | 2007-02-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.