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NPI Code Detail

MEDICARE: NICOLE PERIGARD RD

MEDICARE: NICOLE PERIGARD 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
1133V00000XRegistered Dietitian1049396WA

General Provider Information

NPI Number : 1619422193
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE PERIGARD RD
Provider Business Mailing Address
First Line : PO BOX 34703
Second Line :
City : SEATTLE
State : WA
Zip : 98124-1703
Country : US
Telephone Number : 206-764-0502
Fax Number : 206-764-0516
Provider Business Practice Location Address
First Line : 8801 14TH AVE S
Second Line :
City : SEATTLE
State : WA
Zip : 98108-4809
Country : US
Telephone Number : 206-764-0502
Fax Number : 206-764-0516
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2016
Last Update Date : 08/24/2016

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Directions to “ NICOLE PERIGARD RD” Practice Location

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