Provider Demographics
NPI:1245091388
Name:PURCELL, ALEXANDRIA NICHOLE (RDN)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:NICHOLE
Last Name:PURCELL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 MUIRHEAD AVE NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4155
Mailing Address - Country:US
Mailing Address - Phone:360-252-9478
Mailing Address - Fax:
Practice Address - Street 1:2312 MUIRHEAD AVE NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4155
Practice Address - Country:US
Practice Address - Phone:360-252-9478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60981961133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered