Basic Information
| Provider Information | |||||||||
| NPI: | 1487601142 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAHLER | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MNT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4220 132ND ST SE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MILL CREEK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980128999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253579380 | ||||||||
| FaxNumber: | 4253579382 | ||||||||
| Practice Location | |||||||||
| Address1: | 11700 MUKILTEO SPEEDWAY | ||||||||
| Address2: | SUITE 503 | ||||||||
| City: | MUKILTEO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982755432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253499692 | ||||||||
| FaxNumber: | 4253499694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 12/03/2014 | ||||||||
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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 | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 7758854 | 01 | WA | AETNA | OTHER | 4877MA | 01 | WA | REGENCE BLUE SHIELD | OTHER | 8905619 | 01 | WA | L&I CRIME VICTIMS | OTHER | 9173MA | 01 | WA | REGENCE BLUE SHIELD | OTHER | 8425126 | 05 | WA | MEDICAID | 379172610 | 01 | WA | OWCP | OTHER |