Provider Demographics
NPI:1609583871
Name:LAVINE, NAVA MATANYA (RD, CD)
Entity Type:Individual
Prefix:
First Name:NAVA
Middle Name:MATANYA
Last Name:LAVINE
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 1:7701 16TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5420
Mailing Address - Country:US
Mailing Address - Phone:310-817-1347
Mailing Address - Fax:
Practice Address - Street 1:16404 SMOKEY POINT BLVD STE 308
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-7060
Practice Address - Country:US
Practice Address - Phone:360-230-8202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61336411133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered