Provider Demographics
NPI:1467661090
Name:PEARSON, ADINA B (RD)
Entity Type:Individual
Prefix:
First Name:ADINA
Middle Name:B
Last Name:PEARSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ADINA
Other - Middle Name:B
Other - Last Name:TAPU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:304 N COLLEGE AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-1022
Mailing Address - Country:US
Mailing Address - Phone:509-295-2923
Mailing Address - Fax:
Practice Address - Street 1:19 E BIRCH ST STE 102
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3205
Practice Address - Country:US
Practice Address - Phone:509-295-2923
Practice Address - Fax:509-396-5520
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001534133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered