MEDICARE: ELIZABETH PAYNE RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1154732170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH PAYNE RD

Provider Business Mailing Address
First Line	:	1756 S SPOKANE ST APT 304
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-6646
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 10TH AVE E STE 6
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-4377
Country	:	US
Telephone Number	:	206-337-1670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2014
Last Update Date	:	07/15/2021

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Directions to “ ELIZABETH PAYNE RD” Practice Location

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