Healthcare Provider Details

I. General information

NPI: 1013965086
Provider Name (Legal Business Name): MARCELLE A. THURSTON R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE BOX 359735
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

325 9TH AVE BOX 359735
SEATTLE WA
98104-2420
US

V. Phone/Fax

Practice location:
  • Phone: 206-341-4612
  • Fax: 206-341-4614
Mailing address:
  • Phone: 206-341-4612
  • Fax: 206-341-4614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI00001519
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: