Active NPI
Selena Moffitt
- Nutritionist
- Portland, OR
National Provider Identifier
1689076796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- Practice address
- 5331 SW Macadam Ave Ste 380
Portland, OR 97239-3879 - Phone
- (503) 894-9118
- NPI assigned
- Sep 19, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | Primary |
Addresses
Primary practice location
5331 SW Macadam Ave Ste 380
Portland, OR 97239-3879
Mailing address
12850 SE 257TH Ave
Damascus, OR 97089
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411084800000",
"number": "1689076796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12850 SE 257TH AVE",
"city": "DAMASCUS",
"state": "OR",
"postal_code": "97089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5331 SW MACADAM AVE STE 380",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972393879",
"telephone_number": "503-894-9118"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOFFITT",
"first_name": "SELENA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-09-19",
"last_updated": "2014-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.