Provider Demographics
NPI:1639133556
Name:DUREK, /ELSPETH MARY JOAN (RD, CD)
Entity Type:Individual
Prefix:
First Name:/ELSPETH
Middle Name:MARY JOAN
Last Name:DUREK
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 1:8114 NE 229TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-9790
Mailing Address - Country:US
Mailing Address - Phone:360-891-9817
Mailing Address - Fax:
Practice Address - Street 1:8114 NE 229TH CT
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-9790
Practice Address - Country:US
Practice Address - Phone:360-891-9817
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000573133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered