NPIMap

Organization Active NPI

CMB Nutrition & Wellness

  • Registered Dietitian
  • Troutdale, OR
National Provider Identifier
1780217018
Registry record updated Feb 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
CMB NUTRITION & WELLNESS
Practice address
612 SW 25TH Cir
Troutdale, OR 97060-1891
Phone
(775) 230-3787
NPI assigned
Feb 14, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Breanna Wilson, MS, RD, LDNPI 1760737837
Title
Registered Dietitian/Part Owner
Phone
(775) 230-3787

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X Primary

Addresses

Primary practice location

612 SW 25TH Cir
Troutdale, OR 97060-1891

Mailing address

612 SW 25TH Cir
Troutdale, OR 97060-1891

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581638400000",
    "number": "1780217018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 SW 25TH CIR",
            "city": "TROUTDALE",
            "state": "OR",
            "postal_code": "970601891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 SW 25TH CIR",
            "city": "TROUTDALE",
            "state": "OR",
            "postal_code": "970601891",
            "telephone_number": "775-230-3787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CMB NUTRITION & WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-14",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "BREANNA",
        "authorized_official_title_or_position": "REGISTERED DIETITIAN/PART OWNER",
        "authorized_official_telephone_number": "775-230-3787",
        "authorized_official_credential": "MS, RD, LD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Troutdale, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.