MEDICARE: MS. MARIA T NARDELLA 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	DI00000865	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DI00000865	OTHER	WA	WASHINGTON STATE DIETITIAN CERTIFICATION

General Provider Information

NPI Number	:	1740624378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA T NARDELLA RD

Provider Business Mailing Address
First Line	:	1800 CAMELOT PARK SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98512-5577
Country	:	US
Telephone Number	:	360-705-3932
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 CAMELOT PARK SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98512-5577
Country	:	US
Telephone Number	:	360-705-3932
Fax Number	:

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

Provider Enumeration Date	:	04/25/2013
Last Update Date	:	04/25/2013

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