Facts
- Status
- A
- Credential
- Registered Dietitian
- Type
- Individual
- Enumeration date
- 2025-01-23
- Last updated
- 2025-01-24
Licenses
- License TX
- DT91611
- License CT
- 002726
- License IL
- 164.011331
- License FL
- TPND586
- License WA
- DI61488716
Location
- Practice location
- 3584 EDITH AVE
- City
- ENUMCLAW WA
- Postal code
- 980225098
- Phone
- 630-881-2883
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.