Provider Demographics
NPI:1063244218
Name:EVOLVE NUTRITION
Entity type:Organization
Organization Name:EVOLVE NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED DIETITIAN
Authorized Official - Phone:818-585-5400
Mailing Address - Street 1:17507 153RD STREET CT NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98329-5673
Mailing Address - Country:US
Mailing Address - Phone:818-585-5400
Mailing Address - Fax:206-495-6674
Practice Address - Street 1:2702 N PROCTOR ST STE F
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-5228
Practice Address - Country:US
Practice Address - Phone:818-585-5400
Practice Address - Fax:206-495-6674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty