Provider Demographics
NPI:1922195940
Name:SERRA, JARI LYNNE (RD)
Entity Type:Individual
Prefix:MS
First Name:JARI
Middle Name:LYNNE
Last Name:SERRA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:JARI
Other - Middle Name:LYNNE
Other - Last Name:KNUDSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4521 S DONALD CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4454
Mailing Address - Country:US
Mailing Address - Phone:509-448-4067
Mailing Address - Fax:509-838-4042
Practice Address - Street 1:3424 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203
Practice Address - Country:US
Practice Address - Phone:509-838-5800
Practice Address - Fax:509-838-4042
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00015125101Y00000X
WADI00000931133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No101Y00000XBehavioral Health & Social Service ProvidersCounselor