Provider Demographics
NPI:1417359092
Name:MUNDAY, RENE (CN)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:MUNDAY
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13203 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4049
Mailing Address - Country:US
Mailing Address - Phone:805-428-3771
Mailing Address - Fax:
Practice Address - Street 1:13203 15TH AVE NE
Practice Address - Street 2:SUITE 818
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4049
Practice Address - Country:US
Practice Address - Phone:805-428-3771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU 60345834133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education