Healthcare Provider Details

I. General information

NPI: 1093634073
Provider Name (Legal Business Name): LINDA ALICE EDWARDS NUTRITION COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2642 NE 184TH PL
LK FOREST PK WA
98155-4060
US

IV. Provider business mailing address

2642 NE 184TH PL
LK FOREST PK WA
98155-4060
US

V. Phone/Fax

Practice location:
  • Phone: 206-353-6001
  • Fax:
Mailing address:
  • Phone: 206-353-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberNUTR.NU.70140107
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: