Basic Information
| Provider Information | |||||||||
| NPI: | 1467698910 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FURRER | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MS, RD, CD,CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3360 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972083360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667472455 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1010 S SCHEUBER RD | ||||||||
| Address2: | PMG SW WA DM MNT CENTRALIA | ||||||||
| City: | CENTRALIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985318892 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608077960 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2009 | ||||||||
| LastUpdateDate: | 03/06/2014 | ||||||||
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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 | DI00000833 | WA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | DI00000833 | 01 | WA | WA STATE DOH CREDENTIAL NUMBER FOR DIETITIAN CERTIFICATION | OTHER |