Provider Demographics
NPI:1639694813
Name:BERNARD, PERRI LYNN (RDN)
Entity Type:Individual
Prefix:
First Name:PERRI
Middle Name:LYNN
Last Name:BERNARD
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4679 173RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-6538
Mailing Address - Country:US
Mailing Address - Phone:206-919-6555
Mailing Address - Fax:
Practice Address - Street 1:4679 173RD AVE SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-6538
Practice Address - Country:US
Practice Address - Phone:206-919-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA579467133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered