Provider Demographics
NPI:1558958678
Name:JARRAHIAN, ROSE MICHELLE (RDN)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MICHELLE
Last Name:JARRAHIAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:MICHELLE
Other - Last Name:FISHBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15407 38TH DR SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-4504
Mailing Address - Country:US
Mailing Address - Phone:425-231-2065
Mailing Address - Fax:
Practice Address - Street 1:1750 112TH AVE NE STE A101
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3782
Practice Address - Country:US
Practice Address - Phone:425-688-5846
Practice Address - Fax:425-688-5281
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA86091477133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered