=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770193245
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NUMENA NUTRITION PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2020
-----------------------------------------------------
Last Update Date | 08/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13003 20TH AVE NE
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98125-4121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-256-5047
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13003 20TH AVE NE
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98125-4121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-256-5047
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-FOUNDER OF NUMENA NUTRITION
-----------------------------------------------------
Name | NEGIN EBRAHIMIFARD
-----------------------------------------------------
Credential | RDN, CDCES, CNSC, CD
-----------------------------------------------------
Telephone | 520-256-5047
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133NN1002X
-----------------------------------------------------
Taxonomy Name | Nutrition Education Nutritionist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------