Basic Information
| Provider Information | |||||||||
| NPI: | 1205022688 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CULLEN | ||||||||
| FirstName: | JEANNE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS, RD, CD, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3103 SW MYRTLE ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981263305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063532855 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3377 RIVERBEND DR | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974778803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412222700 | ||||||||
| FaxNumber: | 5412226113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DI00001105 | WA | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | D10187258 | OR | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.