Provider Demographics
NPI:1598155699
Name:MYERS, NANCY JOAN (RD)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JOAN
Last Name:MYERS
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 1:311 140TH ST S
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98444-4526
Mailing Address - Country:US
Mailing Address - Phone:253-536-5961
Mailing Address - Fax:253-536-5967
Practice Address - Street 1:311 140TH ST S
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:WA
Practice Address - Zip Code:98444-4526
Practice Address - Country:US
Practice Address - Phone:253-536-5961
Practice Address - Fax:253-536-5967
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 60134730133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered