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General NPI Number Information
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NPI Number | 1013365287
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Entity Type | Organization
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Legal Business Name | RESILIENT HEALTH
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Dates
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Enumeration Date | 05/29/2016
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Last Update Date | 05/29/2016
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Provider Practice Location Address
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Address Line | 7713 CENTER BLVD SE SUITE 160
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City | SNOQUALMIE
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State | WA
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Zip | 98065-6319
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Country | US
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Telephone | 707-536-6686
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Fax |
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Provider Business Mailing Address
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Address Line | 450 NW GILMAN BLVD SUITE 201
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City | ISSAQUAH
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State | WA
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Zip | 98027-2483
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Country | US
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Telephone | 707-536-6686
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Fax |
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Authorized Official
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Title or Position | NUTRITIONIST
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Name | ANISA WOODALL
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Credential | MS CN
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Telephone | 707-536-6686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | NU60584285
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License Number State | WA
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