MEDICARE: JAIME ELIZABETH THORPE 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	DI60923637	WA

General Provider Information

NPI Number	:	1770048605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME ELIZABETH THORPE RD

Provider Business Mailing Address
First Line	:	603 S J ST APT 416
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-4169
Country	:	US
Telephone Number	:	973-879-9924
Fax Number	:

Provider Business Practice Location Address
First Line	:	673 WOODLAND SQUARE LOOP SE STE 330
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98503-1066
Country	:	US
Telephone Number	:	888-364-5977
Fax Number	:

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

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	02/05/2019

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