Provider Demographics
NPI:1720156565
Name:LAW, MARY B (RD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:LAW
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9625 24TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-2504
Mailing Address - Country:US
Mailing Address - Phone:206-706-0456
Mailing Address - Fax:
Practice Address - Street 1:10808 NE 145TH ST
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-5200
Practice Address - Country:US
Practice Address - Phone:206-296-9813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA887767OtherCDR LICENSE
WA8270092Medicaid