Provider Demographics
NPI:1154665602
Name:BLAIR, WENDY (RD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SW 39TH ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4915
Mailing Address - Country:US
Mailing Address - Phone:253-350-4477
Mailing Address - Fax:253-630-2292
Practice Address - Street 1:500 SW 39TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4915
Practice Address - Country:US
Practice Address - Phone:253-350-4477
Practice Address - Fax:253-630-2292
Is Sole Proprietor?:No
Enumeration Date:2012-11-22
Last Update Date:2012-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000742133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered