Provider Demographics
NPI:1336357193
Name:MALTERRE, THOMAS ANDREW (MS, CN)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANDREW
Last Name:MALTERRE
Suffix:
Gender:M
Credentials:MS, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 W MAGNOLIA ST
Mailing Address - Street 2:SUITE 445
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4368
Mailing Address - Country:US
Mailing Address - Phone:360-752-1774
Mailing Address - Fax:360-733-3941
Practice Address - Street 1:114 W MAGNOLIA ST
Practice Address - Street 2:SUITE 445
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4368
Practice Address - Country:US
Practice Address - Phone:360-752-1774
Practice Address - Fax:360-733-3941
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU00001724133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist