Healthcare Provider Details

I. General information

NPI: 1154948503
Provider Name (Legal Business Name): HANNAH MARIE BAIN RD, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 11/27/2023
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 OAKESDALE AVE SW
RENTON WA
98057-5224
US

IV. Provider business mailing address

4915 SW 319TH LN APT E303
FEDERAL WAY WA
98023-4123
US

V. Phone/Fax

Practice location:
  • Phone: 425-203-5212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number86117516
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: