Provider Demographics
NPI:1265024640
Name:NISLOW, NATALY ELLA (CNS)
Entity Type:Individual
Prefix:MRS
First Name:NATALY
Middle Name:ELLA
Last Name:NISLOW
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38579 SE RIVER ST STE 15
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-5155
Mailing Address - Country:US
Mailing Address - Phone:425-445-3816
Mailing Address - Fax:
Practice Address - Street 1:38579 SE RIVER ST STE 15
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-5155
Practice Address - Country:US
Practice Address - Phone:425-445-3816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61104713133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist