Healthcare Provider Details

I. General information

NPI: 1639315872
Provider Name (Legal Business Name): MEGAN JANE E NORDLUND RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE BOX 359790
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

325 9TH AVE BOX 359790
SEATTLE WA
98104-2420
US

V. Phone/Fax

Practice location:
  • Phone: 206-645-1235
  • Fax:
Mailing address:
  • Phone: 206-645-1235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number00990272
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number00990272
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number00990272
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number00990272
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI60045205
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: