Provider Demographics
NPI:1154343390
Name:DENIS, HEATHER MELINDA (RD)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MELINDA
Last Name:DENIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MELINDA
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2601 CHERRY AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4214
Mailing Address - Country:US
Mailing Address - Phone:360-744-6910
Mailing Address - Fax:360-744-6919
Practice Address - Street 1:2601 CHERRY AVE STE 115
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4214
Practice Address - Country:US
Practice Address - Phone:360-744-6910
Practice Address - Fax:360-744-6919
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001553133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0039581OtherL & I
WA8452294Medicaid
WAUS7035773OtherAETNA/USHC PCP
WA8496STOtherINDIVIDUAL BLUE SHIELD
WAUS7035773OtherAETNA/USHC PCP
WA0039581OtherL & I