MEDICARE: MS. MARY S PURDY MS RD

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	NU00002024	WA

General Provider Information

NPI Number	:	1457506040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY S PURDY MS RD

Provider Business Mailing Address
First Line	:	4005 LATONA AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-6539
Country	:	US
Telephone Number	:	206-632-1997
Fax Number	:	206-632-1997

Provider Business Practice Location Address
First Line	:	6300 9TH AVE NE
Second Line	:	STE 200
City	:	SEATTLE
State	:	WA
Zip	:	98115-8515
Country	:	US
Telephone Number	:	206-632-1997
Fax Number	:	206-632-1997

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

Provider Enumeration Date	:	11/24/2008
Last Update Date	:	11/24/2008

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