Healthcare Provider Details

I. General information

NPI: 1417359092
Provider Name (Legal Business Name): RENE MUNDAY CN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 W RIVERSIDE AVE STE N
SPOKANE WA
99201-0580
US

IV. Provider business mailing address

18632 79TH PL W
EDMONDS WA
98026-5814
US

V. Phone/Fax

Practice location:
  • Phone: 206-841-7005
  • Fax:
Mailing address:
  • Phone: 805-428-3771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberNU 60345834
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNU 60345834
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: