Provider Demographics
NPI:1689303141
Name:PASWATERS, PAIGE MICHELLE (RD, CNSC, CP-FS)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:MICHELLE
Last Name:PASWATERS
Suffix:
Gender:F
Credentials:RD, CNSC, CP-FS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 TAYLOR ST APT 307
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1454
Mailing Address - Country:US
Mailing Address - Phone:928-846-1154
Mailing Address - Fax:
Practice Address - Street 1:1225 TAYLOR ST APT 307
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1454
Practice Address - Country:US
Practice Address - Phone:928-846-1154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86058031133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered