Provider Demographics
NPI:1295344067
Name:COSTER, ALI NICOLE (RD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:NICOLE
Last Name:COSTER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ALI
Other - Middle Name:NICOLE
Other - Last Name:COSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11511 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8578
Mailing Address - Country:US
Mailing Address - Phone:425-502-3000
Mailing Address - Fax:844-620-1839
Practice Address - Street 1:1408 3RD ST SE STE 200
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3702
Practice Address - Country:US
Practice Address - Phone:253-268-3345
Practice Address - Fax:253-881-1490
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI61085122133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADI61085122OtherWASHINGTON STATE DEPARTMENT OF HEALTH