Healthcare Provider Details

I. General information

NPI: 1952432296
Provider Name (Legal Business Name): ERWINA BIRDIE PETERSON M.ED.,CFCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 W YAKIMA AVE
YAKIMA WA
98902-2873
US

IV. Provider business mailing address

2310 W YAKIMA AVE
YAKIMA WA
98902-2873
US

V. Phone/Fax

Practice location:
  • Phone: 509-248-6386
  • Fax: 509-248-6386
Mailing address:
  • Phone: 509-248-6386
  • Fax: 509-248-6386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number126042
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: