Provider Demographics
NPI:1063584043
Name:KRUPIN, NANCY ELLIN (MS, RD, CDE)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ELLIN
Last Name:KRUPIN
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 SWIFT BLVD
Mailing Address - Street 2:DIABETES LEARNING CENTER
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-942-2620
Mailing Address - Fax:509-942-2718
Practice Address - Street 1:888 SWIFT BLVD
Practice Address - Street 2:DIABETES LEARNING CENTER
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-942-2620
Practice Address - Fax:509-942-2718
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000881133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8398059Medicaid
WA8398059Medicaid