Provider Demographics
NPI:1952432296
Name:PETERSON, ERWINA BIRDIE (MED,CFCS)
Entity type:Individual
Prefix:MS
First Name:ERWINA
Middle Name:BIRDIE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MED,CFCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 W YAKIMA AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2873
Mailing Address - Country:US
Mailing Address - Phone:509-248-6386
Mailing Address - Fax:509-248-6386
Practice Address - Street 1:2310 W YAKIMA AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2873
Practice Address - Country:US
Practice Address - Phone:509-248-6386
Practice Address - Fax:509-248-6386
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC126042133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education