Provider Demographics
NPI:1457506040
Name:PURDY, MARY S (MS RD)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:S
Last Name:PURDY
Suffix:
Gender:F
Credentials:MS RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 LATONA AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-6539
Mailing Address - Country:US
Mailing Address - Phone:206-632-1997
Mailing Address - Fax:206-632-1997
Practice Address - Street 1:6300 9TH AVE NE
Practice Address - Street 2:STE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-8515
Practice Address - Country:US
Practice Address - Phone:206-632-1997
Practice Address - Fax:206-632-1997
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU00002024133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered