MEDICARE: KATY LANE NUTRITION

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	:	1518770007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATY LANE NUTRITION

Provider Business Mailing Address
First Line	:	3826 NE 86TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-3729
Country	:	US
Telephone Number	:	509-720-8703
Fax Number	:

Provider Business Practice Location Address
First Line	:	3826 NE 86TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-3729
Country	:	US
Telephone Number	:	509-720-8703
Fax Number	:

Authorized Official
Title or Position	:	DIETITIAN / OWNER
Name	:	KATHERINE LANE
Credential	:	RD
Telephone Number	:	509-720-8703

Provider Enumeration Date	:	01/29/2025
Last Update Date	:	01/29/2025

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