Provider Demographics
NPI:1457660730
Name:HENSHAW, MISHA CARTER (MS, RD, CD)
Entity Type:Individual
Prefix:
First Name:MISHA
Middle Name:CARTER
Last Name:HENSHAW
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2747 124TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-4100
Mailing Address - Country:US
Mailing Address - Phone:206-228-8024
Mailing Address - Fax:
Practice Address - Street 1:18323 98TH AVE NE
Practice Address - Street 2:SUITE 3
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3358
Practice Address - Country:US
Practice Address - Phone:425-806-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60187898133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered