Healthcare Provider Details

I. General information

NPI: 1982821195
Provider Name (Legal Business Name): THERESA ELIZABETH MILLER RD,CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MARTIN LUTHER KING JR WAY MS 315 M2 HIN
TACOMA WA
98405-4234
US

IV. Provider business mailing address

PO BOX 5299 MS 315 M2 HIN
TACOMA WA
98415-0299
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-1833
  • Fax: 253-403-1845
Mailing address:
  • Phone: 253-403-1833
  • Fax: 253-403-1845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: