Provider Demographics
NPI:1538668751
Name:SMITH, MICHELLE BRITTANY (MS, RDN, CD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:BRITTANY
Last Name:SMITH
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 1:1200 OLD FAIRHAVEN PKWY STE 303
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7446
Mailing Address - Country:US
Mailing Address - Phone:360-739-1278
Mailing Address - Fax:360-682-3732
Practice Address - Street 1:1200 OLD FAIRHAVEN PKWY STE 303
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7446
Practice Address - Country:US
Practice Address - Phone:360-599-7126
Practice Address - Fax:360-682-3732
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60756162133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADI60756162OtherMICHELLE B SMITH: DIETITIAN CERTIFICATION