Healthcare Provider Details

I. General information

NPI: 1386161990
Provider Name (Legal Business Name): LANI KATE MILLER RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LANI KATE HUDSON RDN

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 BELLWETHER WAY STE 223
BELLINGHAM WA
98225-2914
US

IV. Provider business mailing address

12 BELLWETHER WAY STE 201
BELLINGHAM WA
98225-2914
US

V. Phone/Fax

Practice location:
  • Phone: 360-739-1278
  • Fax:
Mailing address:
  • Phone: 360-739-1278
  • Fax: 425-610-9258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI60738912
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDI60738912
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: