Provider Demographics
NPI:1679778849
Name:WATANABE, ELIZABETH ANN (RDN, DC)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:WATANABE
Suffix:
Gender:F
Credentials:RDN, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 5TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-5124
Mailing Address - Country:US
Mailing Address - Phone:425-931-1194
Mailing Address - Fax:425-955-6830
Practice Address - Street 1:2114 5TH AVE NW
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5124
Practice Address - Country:US
Practice Address - Phone:425-931-1194
Practice Address - Fax:425-955-6830
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI61674519133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK8ED850Medicare PIN