Provider Demographics
NPI:1518451483
Name:PEARCE, SANDRA (RDN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:PEARCE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 60TH LN SE UNIT B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-8430
Mailing Address - Country:US
Mailing Address - Phone:360-280-7607
Mailing Address - Fax:
Practice Address - Street 1:3712 9TH ST SW STE 1A
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3564
Practice Address - Country:US
Practice Address - Phone:855-328-4543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA86111895133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered