Provider Demographics
NPI:1083927719
Name:HUGHES, LEZLY GRACE (DIETITIAN)
Entity Type:Individual
Prefix:
First Name:LEZLY
Middle Name:GRACE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:DIETITIAN
Other - Prefix:
Other - First Name:LEZLY
Other - Middle Name:GRACE
Other - Last Name:DOMINGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DIETITIAN
Mailing Address - Street 1:2209 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-4922
Mailing Address - Country:US
Mailing Address - Phone:253-593-0232
Mailing Address - Fax:253-382-2094
Practice Address - Street 1:2209 E 32ND ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-4922
Practice Address - Country:US
Practice Address - Phone:253-593-0232
Practice Address - Fax:253-382-2094
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001428171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator