Basic Information
| Provider Information | |||||||||
| NPI: | 1598155699 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MYERS | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | JOAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 311 140TH ST S | ||||||||
| Address2: | |||||||||
| City: | PARKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984444526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535365961 | ||||||||
| FaxNumber: | 2535365967 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 140TH ST S | ||||||||
| Address2: | |||||||||
| City: | PARKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984444526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535365961 | ||||||||
| FaxNumber: | 2535365967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2015 | ||||||||
| LastUpdateDate: | 01/27/2015 | ||||||||
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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 | 133V00000X | DI 60134730 | WA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.