MEDICARE: BONNIE SMITH 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	953471	WA

General Provider Information

NPI Number	:	1750247284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE SMITH RD

Provider Business Mailing Address
First Line	:	1959 NE PACIFIC ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-6057
Country	:	US
Telephone Number	:	206-598-6352
Fax Number	:

Provider Business Practice Location Address
First Line	:	1959 NE PACIFIC STREET BOX 356057
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-6057
Country	:	US
Telephone Number	:	206-598-6352
Fax Number	:

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

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	12/29/2025

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Directions to “ BONNIE SMITH RD” Practice Location

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