Healthcare Provider Details

I. General information

NPI: 1881769701
Provider Name (Legal Business Name): ELIZABETH CLAIRE DUROE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W OLYMPIC PL APT 109
SEATTLE WA
98119-3750
US

IV. Provider business mailing address

220 WEST OLYMPIC PLACE #109
SEATTLE WA
98119
US

V. Phone/Fax

Practice location:
  • Phone: 206-890-3911
  • Fax:
Mailing address:
  • Phone: 206-890-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDI00001360
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: