Provider Demographics
NPI:1205056405
Name:RIEGERT, LAURIE LITTON (DI)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:LITTON
Last Name:RIEGERT
Suffix:
Gender:F
Credentials:DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 S HILLS DR
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-3214
Mailing Address - Country:US
Mailing Address - Phone:509-664-3771
Mailing Address - Fax:509-664-6753
Practice Address - Street 1:504 ORONDO AVE
Practice Address - Street 2:STE C
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2830
Practice Address - Country:US
Practice Address - Phone:509-664-3771
Practice Address - Fax:509-664-6753
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000616133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8259822Medicaid