Provider Demographics
NPI:1467841015
Name:FOTHERINGHAM, KORRIN (MS, RDN, CD)
Entity Type:Individual
Prefix:
First Name:KORRIN
Middle Name:
Last Name:FOTHERINGHAM
Suffix:
Gender:F
Credentials:MS, RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19818 N NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:WA
Mailing Address - Zip Code:99021-9792
Mailing Address - Country:US
Mailing Address - Phone:425-922-2303
Mailing Address - Fax:509-931-0495
Practice Address - Street 1:400 S JEFFERSON ST STE 200E
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3149
Practice Address - Country:US
Practice Address - Phone:425-922-2303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 60504831133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered