1386138907 NPI number — MRS. AMANDA FRANCES ELLIS REGISTERED DIETITIAN

Table of content: MRS. AMANDA FRANCES ELLIS REGISTERED DIETITIAN (NPI 1386138907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386138907 NPI number — MRS. AMANDA FRANCES ELLIS REGISTERED DIETITIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLIS
Provider First Name:
AMANDA
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED DIETITIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386138907
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
915 118TH AVE SE, ATTENTION ALECIA JOHNSON, RET PHYSICA
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-243-6922
Provider Business Mailing Address Fax Number:
425-452-0704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 118TH AVE SE, ATTENTION ALECIA JOHNSON, RET PHYSICA
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-243-6922
Provider Business Practice Location Address Fax Number:
425-452-0704
Provider Enumeration Date:
06/18/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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