Provider Demographics
NPI:1891834487
Name:PICCININ, DORIS (MS RD CDE)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:PICCININ
Suffix:
Gender:F
Credentials:MS RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34936
Mailing Address - Street 2:DEPT 1025
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1936
Mailing Address - Country:US
Mailing Address - Phone:206-834-4183
Mailing Address - Fax:206-834-4131
Practice Address - Street 1:14500 JUANITA DR NE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-4966
Practice Address - Country:US
Practice Address - Phone:425-602-3099
Practice Address - Fax:206-834-4131
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA808960133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered