Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1545 | OR |
NPI | 1033325568 |
---|---|
Provider Name | Dr. Patrick Richard Arden |
First Address | Stayton, OR 97383-1755 |
Second Address | Stayton, OR 97383-1755 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 08/07/2007 |