Provider Demographics
NPI:1851170781
Name:PHILLIPS, GENEVIEVE BIANCA (RD)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:BIANCA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12901 20TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98168-5159
Mailing Address - Country:US
Mailing Address - Phone:206-901-8758
Mailing Address - Fax:
Practice Address - Street 1:12901 20TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98168-5159
Practice Address - Country:US
Practice Address - Phone:206-901-8758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60224436133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered