Provider Demographics
NPI:1588177216
Name:FITCH, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:FITCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:GROMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD/RDN
Mailing Address - Street 1:400 108TH AVE NE STE 402
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 108TH AVE NE STE 402
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5508
Practice Address - Country:US
Practice Address - Phone:425-454-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60742610133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered