Provider Demographics
NPI:1598949810
Name:PITIGLIANO, AUDREY L (CN)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:L
Last Name:PITIGLIANO
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5725 104TH ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-4224
Mailing Address - Country:US
Mailing Address - Phone:253-988-0967
Mailing Address - Fax:253-848-5224
Practice Address - Street 1:1818 MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1849
Practice Address - Country:US
Practice Address - Phone:253-988-0967
Practice Address - Fax:253-848-5224
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist