Provider Demographics
NPI:1104915057
Name:CUMBIE, ELAINE CLAIRE (MA, RD,CDE)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:CLAIRE
Last Name:CUMBIE
Suffix:
Gender:F
Credentials:MA, RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 KENNEDY AVE SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-0805
Mailing Address - Country:US
Mailing Address - Phone:253-804-6521
Mailing Address - Fax:
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:M/S 3726
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-1222
Practice Address - Fax:206-987-5087
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000759133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8262941Medicaid
WADI00000759OtherSTATE LICENSE
WAR598491OtherDIETETIC REGISTRATION