Provider Demographics
NPI:1790854149
Name:PRENTICE, PATRICIA ABEL (MS, RD)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ABEL
Last Name:PRENTICE
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 1:12712 ADMIRALTY WAY
Mailing Address - Street 2:C203
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-5562
Mailing Address - Country:US
Mailing Address - Phone:425-438-1667
Mailing Address - Fax:
Practice Address - Street 1:10501 MERIDIAN AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9509
Practice Address - Country:US
Practice Address - Phone:206-296-4912
Practice Address - Fax:206-205-3362
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000440133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8270183Medicaid
WAP45081Medicare UPIN