Healthcare Provider Details

I. General information

NPI: 1750752820
Provider Name (Legal Business Name): ERICA VAN MIEGHEM MS, RD, CD, CN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W HOLLY ST SUITE 2D
BELLINGHAM WA
98225-2940
US

IV. Provider business mailing address

PO BOX 5791
BELLINGHAM WA
98227-5791
US

V. Phone/Fax

Practice location:
  • Phone: 206-902-8000
  • Fax: 360-656-6724
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number60183469
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number977132
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: