Provider Demographics
NPI:1316366859
Name:CHISLETT, DIANA (RD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:CHISLETT
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 1:1601 114TH AVE SE
Mailing Address - Street 2:#180
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6950
Mailing Address - Country:US
Mailing Address - Phone:425-451-1134
Mailing Address - Fax:425-451-8501
Practice Address - Street 1:1601 114TH AVE SE
Practice Address - Street 2:#180
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6950
Practice Address - Country:US
Practice Address - Phone:425-451-1134
Practice Address - Fax:425-451-8501
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60303384133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered