Provider Demographics
NPI:1174037402
Name:NORTH SOUND NOURISHMENT AND RECOVERY LLC
Entity Type:Organization
Organization Name:NORTH SOUND NOURISHMENT AND RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN & OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, CD
Authorized Official - Phone:206-660-3225
Mailing Address - Street 1:3213 WETMORE AVE APT 13
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4365
Mailing Address - Country:US
Mailing Address - Phone:206-660-3225
Mailing Address - Fax:425-328-1891
Practice Address - Street 1:3213 WETMORE AVE APT 13
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4365
Practice Address - Country:US
Practice Address - Phone:206-660-3225
Practice Address - Fax:425-328-1891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-22
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001163133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Single Specialty