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General NPI Number Information
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NPI Number | 1063960615
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Entity Type | Individual
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Provider Name | ROBERT WAYNE DEMKO C.N.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 2522 N PROCTOR ST # 425
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City | TACOMA
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State | WA
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Zip | 98406-5338
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Country | US
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Telephone | 844-705-0990
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Fax | 253-444-0514
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Provider Business Mailing Address
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Address Line | 2522 N PROCTOR ST # 425
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City | TACOMA
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State | WA
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Zip | 98406-5338
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Country | US
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Telephone | 844-705-0990
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Fax | 253-444-0514
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | CN 60687076
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License Number State | WA
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