Provider Demographics
NPI:1770155095
Name:FOTOVICH, KATRINA (MS, RD)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:FOTOVICH
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SW 5TH CT APT K402
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5874
Mailing Address - Country:US
Mailing Address - Phone:256-665-4319
Mailing Address - Fax:
Practice Address - Street 1:600 SW 5TH CT APT K402
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5874
Practice Address - Country:US
Practice Address - Phone:256-665-4319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86093276133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered