Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2500 | WA |
NPI | 1043467475 |
---|---|
Provider Name | Dr. Amy Elizabeth Prestas |
First Address | Seattle, WA 98102-3203 |
Second Address | Seattle, WA 98102-3203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2008 |
Last Update Date | 27/08/2008 |