Provider Demographics
NPI:1306210851
Name:HO, PUI LAM ADRIANA (RD)
Entity Type:Individual
Prefix:
First Name:PUI LAM ADRIANA
Middle Name:
Last Name:HO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ADRIANA
Other - Middle Name:
Other - Last Name:HO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:1408 3RD ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3702
Mailing Address - Country:US
Mailing Address - Phone:252-268-3345
Mailing Address - Fax:253-881-1490
Practice Address - Street 1:1408 3RD ST SE STE 200
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372
Practice Address - Country:US
Practice Address - Phone:252-268-3345
Practice Address - Fax:253-881-1490
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60599868133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA86058872OtherRD CERTIFICATION
WADI60599868OtherSTATE LICENSE