Provider Demographics
NPI:1346360211
Name:OSTERBACK, CARITA (RD)
Entity Type:Individual
Prefix:
First Name:CARITA
Middle Name:
Last Name:OSTERBACK
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 1:8843 NE 116TH PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6113
Mailing Address - Country:US
Mailing Address - Phone:425-688-5485
Mailing Address - Fax:
Practice Address - Street 1:1120 112TH AVE NE STE 150
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4505
Practice Address - Country:US
Practice Address - Phone:425-688-5485
Practice Address - Fax:425-688-5281
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA410790133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB28930Medicare UPIN