MEDICARE: MARYLOU ANDERSON CD

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	DI00000830	WA

General Provider Information

NPI Number	:	1922117654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYLOU ANDERSON CD

Provider Business Mailing Address
First Line	:	1002 E SENECA ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-4214
Country	:	US
Telephone Number	:	206-957-1666
Fax Number	:	206-325-2689

Provider Business Practice Location Address
First Line	:	1002 E SENECA ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-4214
Country	:	US
Telephone Number	:	206-957-1666
Fax Number	:	206-325-2689

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	08/15/2008

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