Provider Demographics
NPI:1679876338
Name:DE WULF, MARTA (NUTRITIONIST, BS)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:DE WULF
Suffix:
Gender:F
Credentials:NUTRITIONIST, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 112TH AVE NE
Mailing Address - Street 2:SUITE 220W
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-761-4774
Mailing Address - Fax:
Practice Address - Street 1:12342 NE 26TH PL
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005
Practice Address - Country:US
Practice Address - Phone:425-761-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist