Provider Demographics
NPI:1518647619
Name:MARSTERS, MARTHA ROSE (RD)
Entity Type:Individual
Prefix:
First Name:MARTHA ROSE
Middle Name:
Last Name:MARSTERS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 3RD PL S UNIT A
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6654
Mailing Address - Country:US
Mailing Address - Phone:413-834-1202
Mailing Address - Fax:
Practice Address - Street 1:735 3RD PL S UNIT A
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6654
Practice Address - Country:US
Practice Address - Phone:413-834-1202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA86290199133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered