Provider Demographics
NPI:1083867188
Name:EVANS, PAIGE ANN (RD)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:ANN
Last Name:EVANS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:ANN
Other - Last Name:CADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3432 S BAY RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-2958
Mailing Address - Country:US
Mailing Address - Phone:360-493-7567
Mailing Address - Fax:
Practice Address - Street 1:3432 S BAY RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-2958
Practice Address - Country:US
Practice Address - Phone:360-493-7567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA855528133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA855528OtherRD REGISTRATION NUMBER