Provider Demographics
NPI:1255995973
Name:FACCHINE, EVANGELIA NICOLE (RD CD)
Entity type:Individual
Prefix:MRS
First Name:EVANGELIA
Middle Name:NICOLE
Last Name:FACCHINE
Suffix:
Gender:F
Credentials:RD CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5811 187TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8620
Mailing Address - Country:US
Mailing Address - Phone:732-986-2633
Mailing Address - Fax:
Practice Address - Street 1:5811 187TH AVE SE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8620
Practice Address - Country:US
Practice Address - Phone:732-986-2633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60888449133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered