Provider Demographics
NPI:1346646189
Name:FLORA, STEPHANIE (RD, CD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:FLORA
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 WESTLAKE AVE N
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3012
Mailing Address - Country:US
Mailing Address - Phone:360-220-1190
Mailing Address - Fax:
Practice Address - Street 1:1700 WESTLAKE AVE N
Practice Address - Street 2:SUITE 700
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3012
Practice Address - Country:US
Practice Address - Phone:360-220-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1060761133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered