Provider Demographics
NPI:1215256730
Name:ZAKRAJSEK, DIANE (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ZAKRAJSEK
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9332 318TH PL NE
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-9741
Mailing Address - Country:US
Mailing Address - Phone:206-595-3185
Mailing Address - Fax:
Practice Address - Street 1:26502 NE VALLEY STREET SUITE 102
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019
Practice Address - Country:US
Practice Address - Phone:206-595-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000926133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered