Healthcare Provider Details

I. General information

NPI: 1538451935
Provider Name (Legal Business Name): PACIFIC NUTRITION & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21827 76TH AVE W SUITE 202
EDMONDS WA
98026-7981
US

IV. Provider business mailing address

21827 76TH AVE W SUITE 202
EDMONDS WA
98026-7981
US

V. Phone/Fax

Practice location:
  • Phone: 425-776-7333
  • Fax: 425-776-8373
Mailing address:
  • Phone: 425-776-7333
  • Fax: 425-776-8373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI00002069
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI00000424
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00124642
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI00001610
License Number StateWA

VIII. Authorized Official

Name: MS. MELANIE P MACHADO
Title or Position: CEO
Credential: RD, CD
Phone: 425-776-7333