Provider Demographics
NPI:1013365287
Name:RESILIENT HEALTH
Entity Type:Organization
Organization Name:RESILIENT HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:ANISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODALL
Authorized Official - Suffix:
Authorized Official - Credentials:MS CN
Authorized Official - Phone:707-536-6686
Mailing Address - Street 1:450 NW GILMAN BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2483
Mailing Address - Country:US
Mailing Address - Phone:707-536-6686
Mailing Address - Fax:
Practice Address - Street 1:7713 CENTER BLVD SE
Practice Address - Street 2:SUITE 160
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-6319
Practice Address - Country:US
Practice Address - Phone:707-536-6686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-29
Last Update Date:2016-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU60584285133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty