Provider Demographics
NPI:1740624378
Name:NARDELLA, MARIA T (RD)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:T
Last Name:NARDELLA
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 1:1800 CAMELOT PARK SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-5577
Mailing Address - Country:US
Mailing Address - Phone:360-705-3932
Mailing Address - Fax:
Practice Address - Street 1:1800 CAMELOT PARK SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-5577
Practice Address - Country:US
Practice Address - Phone:360-705-3932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000865133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADI00000865OtherWASHINGTON STATE DIETITIAN CERTIFICATION