Provider Demographics
NPI:1235798273
Name:WITTENHAGEN, EMILY JEAN (CN)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:JEAN
Last Name:WITTENHAGEN
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6248 FLORA AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-2742
Mailing Address - Country:US
Mailing Address - Phone:978-257-0630
Mailing Address - Fax:
Practice Address - Street 1:6248 FLORA AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-2742
Practice Address - Country:US
Practice Address - Phone:978-257-0630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60932426133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist