Healthcare Provider Details

I. General information

NPI: 1679876338
Provider Name (Legal Business Name): MARTA DE WULF NUTRITIONIST, BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12342 NE 26TH PL
BELLEVUE WA
98005
US

IV. Provider business mailing address

1800 112TH AVE NE SUITE 220W
BELLEVUE WA
98004
US

V. Phone/Fax

Practice location:
  • Phone: 425-761-4774
  • Fax:
Mailing address:
  • Phone: 425-761-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: