Provider Demographics
NPI:1942791652
Name:DELAVARI, NORA (RD)
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:
Last Name:DELAVARI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:NORA
Other - Middle Name:JAFARIAN
Other - Last Name:NASERIZAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19930 BALLINGER WAY NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1223
Mailing Address - Country:US
Mailing Address - Phone:425-778-2220
Mailing Address - Fax:425-778-7701
Practice Address - Street 1:19930 BALLINGER WAY NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-1223
Practice Address - Country:US
Practice Address - Phone:425-778-2220
Practice Address - Fax:425-778-7701
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60839317133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADI60839317OtherMEDICAL LICENSE