| Doctor Name: | BIANCA WYATT |
| NPI Number: | 1578822813 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD, LD, CNSC |
| License Number: | LD-D-10147476 |
| Business Practice Address: | 240 Phelps St Silverton, OR - 973811927 |
| Business Phone Number: | 5038731560 |
| Business Fax Number: | |
| Mailing Address: | 342 Fairview St, SILVERTON |
| State: | OR |
| Postal Code: | 973811917 |
| Phone Number: | 5038731500 |
| Fax Number: | |
| NPI Enumeration Date: | 05/07/2012 |
| NPI Last Update Date: | 05/07/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | LD-D-10147476 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |