Provider Demographics
NPI:1356854293
Name:SMITH, MARY E (RD)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:SMITH
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 1:11135 59TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-2825
Mailing Address - Country:US
Mailing Address - Phone:425-293-1126
Mailing Address - Fax:
Practice Address - Street 1:3315 S 23RD ST STE 210
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1616
Practice Address - Country:US
Practice Address - Phone:425-820-0869
Practice Address - Fax:425-820-1745
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered