Basic Information
| Provider Information | |||||||||
| NPI: | 1265604169 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRANCE | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | |||||||||
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| Credential: | RD, CD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 909 N BROADWAY | ||||||||
| Address2: | PBO | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982011409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253170264 | ||||||||
| FaxNumber: | 4253170291 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 N BROADWAY | ||||||||
| Address2: | SUITE A-3 | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982011586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253170300 | ||||||||
| FaxNumber: | 4253170303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2008 | ||||||||
| LastUpdateDate: | 01/30/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 132700000X | DI00002030 | WA | N | Dietary & Nutritional Service Providers | Dietary Manager | 133N00000X | DI00002030 | WA | N | Dietary & Nutritional Service Providers | Nutritionist | 133NN1002X | DI00002030 | WA | N | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | 133V00000X | DI00002030 | WA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | 133VN1004X | DI00002030 | WA | N | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Pediatric | 133VN1005X | DI00002030 | WA | N | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Renal | 133VN1006X | DI00002030 | WA | N | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Metabolic | 136A00000X | DI00002030 | IL | N | Dietary & Nutritional Service Providers | Dietetic Technician, Registered |
ID Information
| ID | Type | State | Issuer | Description | DI00002030 | 01 | WA | WASHINGTON STATE LICENSE | OTHER |