Provider Demographics
NPI:1508107814
Name:HULTIN, VIRGINIA M (MS RDN CSO)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:M
Last Name:HULTIN
Suffix:
Gender:F
Credentials:MS RDN CSO
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:
Other - Last Name:HULTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5146 S BRIGHTON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3425
Mailing Address - Country:US
Mailing Address - Phone:206-227-8998
Mailing Address - Fax:
Practice Address - Street 1:5146 S BRIGHTON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3425
Practice Address - Country:US
Practice Address - Phone:206-227-8998
Practice Address - Fax:206-539-0062
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60633631133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered