Provider Demographics
NPI:1881004950
Name:METTLER, ALEXIS A (MS, RD)
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:A
Last Name:METTLER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 NE 4TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-4100
Mailing Address - Country:US
Mailing Address - Phone:425-656-5377
Mailing Address - Fax:425-656-5429
Practice Address - Street 1:3901 NE 4TH ST STE 105
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056
Practice Address - Country:US
Practice Address - Phone:425-656-5377
Practice Address - Fax:425-656-5429
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60426229133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1881004950Medicaid
WA2084496Medicaid