Healthcare Provider Details

I. General information

NPI: 1891834487
Provider Name (Legal Business Name): DORIS PICCININ M.S. R.D. C.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 JUANITA DR NE
KENMORE WA
98028-4966
US

IV. Provider business mailing address

PO BOX 34936 DEPT 1025
SEATTLE WA
98124-1936
US

V. Phone/Fax

Practice location:
  • Phone: 425-602-3099
  • Fax: 206-834-4131
Mailing address:
  • Phone: 206-834-4183
  • Fax: 206-834-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number808960
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: