MEDICARE: MS. LORELLE DEL MATTO MS, RDN, CD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DI 60321762	WA

General Provider Information

NPI Number	:	1023551926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORELLE DEL MATTO MS, RDN, CD

Provider Business Mailing Address
First Line	:	161 E LAKE SAMMAMISH SHORE LN NE
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98074-6923
Country	:	US
Telephone Number	:	206-228-0792
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 E LAKE SAMMAMISH SHORE LN NE
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98074-6923
Country	:	US
Telephone Number	:	206-228-0792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2016
Last Update Date	:	11/23/2016

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