Provider Demographics
NPI:1548320922
Name:CLAIBORNE, MARISSA SAHARA (RDN, CSR)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:SAHARA
Last Name:CLAIBORNE
Suffix:
Gender:F
Credentials:RDN, CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 TACOMA MALL BLVD
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-6906
Mailing Address - Country:US
Mailing Address - Phone:253-671-3172
Mailing Address - Fax:
Practice Address - Street 1:5825 TACOMA MALL BLVD
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-6906
Practice Address - Country:US
Practice Address - Phone:253-671-3172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA940490133V00000X
WA00001914133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered