Healthcare Provider Details

I. General information

NPI: 1063978831
Provider Name (Legal Business Name): MARIE TYNDALL RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 CORDATA PKWY
BELLINGHAM WA
98226-8037
US

IV. Provider business mailing address

501 E NORTH ST
BELLINGHAM WA
98225-3520
US

V. Phone/Fax

Practice location:
  • Phone: 360-671-3225
  • Fax:
Mailing address:
  • Phone: 360-201-4476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI60935552
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: