Healthcare Provider Details

I. General information

NPI: 1144437864
Provider Name (Legal Business Name): JOAN MILTON DIETITION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 N WASHINGTON ST STE 209
SPOKANE WA
99201-2260
US

IV. Provider business mailing address

122 W 7TH AVE STE 230
SPOKANE WA
99204-2354
US

V. Phone/Fax

Practice location:
  • Phone: 509-232-1192
  • Fax: 509-232-1165
Mailing address:
  • Phone: 509-232-1145
  • Fax: 509-232-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberDI00000651
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: