Healthcare Provider Details

I. General information

NPI: 1235315508
Provider Name (Legal Business Name): MILDRED BRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 SW TRENTON ST
SEATTLE WA
98126-3745
US

IV. Provider business mailing address

15508 SE 183RD DR
RENTON WA
98058-7311
US

V. Phone/Fax

Practice location:
  • Phone: 206-938-6738
  • Fax: 206-938-5217
Mailing address:
  • Phone: 425-652-2158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI00002077
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberDI00002077
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: