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NPI Code Detail

MEDICARE: MARISSA MILES

MEDICARE: MARISSA MILES
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
1133N00000XNutritionist86277139WA
2133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1902539083
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISSA MILES
Provider Business Mailing Address
First Line : 12414 190TH AVENUE CT E
Second Line :
City : BONNEY LAKE
State : WA
Zip : 98391-6027
Country : US
Telephone Number : 253-350-5913
Fax Number :
Provider Business Practice Location Address
First Line : 8301B 5TH AVE NE
Second Line :
City : SEATTLE
State : WA
Zip : 98115-4118
Country : US
Telephone Number : 206-799-7010
Fax Number : 206-866-0204
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2022
Last Update Date : 03/10/2025

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Directions to “ MARISSA MILES ” Practice Location

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