Healthcare Provider Details

I. General information

NPI: 1871157487
Provider Name (Legal Business Name): NUTRITION WITH HEART LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 4TH AVE N
EDMONDS WA
98020-3116
US

IV. Provider business mailing address

221 4TH AVE N
EDMONDS WA
98020-3116
US

V. Phone/Fax

Practice location:
  • Phone: 509-481-0884
  • Fax:
Mailing address:
  • Phone: 509-481-0884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL JAMES LYNCH
Title or Position: FOUNDER
Credential: REGISTERED DIETITIAN
Phone: 509-481-0884