Basic Information
| Provider Information | |||||||||
| NPI: | 1538668751 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | BRITTANY | ||||||||
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| Credential: | MS, RDN, CD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 OLD FAIRHAVEN PKWY STE 303 | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982257446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607391278 | ||||||||
| FaxNumber: | 3606823732 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 OLD FAIRHAVEN PKWY STE 303 | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982257446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605997126 | ||||||||
| FaxNumber: | 3606823732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2018 | ||||||||
| LastUpdateDate: | 01/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DI60756162 | WA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | DI60756162 | 01 | WA | MICHELLE B SMITH: DIETITIAN CERTIFICATION | OTHER |