Provider Demographics
NPI:1609074426
Name:DOLSTAD, WENDE (RD CD)
Entity Type:Individual
Prefix:
First Name:WENDE
Middle Name:
Last Name:DOLSTAD
Suffix:
Gender:F
Credentials:RD CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1507
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-1507
Mailing Address - Country:US
Mailing Address - Phone:360-416-7595
Mailing Address - Fax:360-416-7599
Practice Address - Street 1:330 PACIFIC PL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5427
Practice Address - Country:US
Practice Address - Phone:360-416-7595
Practice Address - Fax:360-416-7599
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001525133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8384448Medicaid