Provider Demographics
NPI:1215598123
Name:PENDLETON, TAWNI L (CN)
Entity type:Individual
Prefix:
First Name:TAWNI
Middle Name:L
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33636 130TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8577
Mailing Address - Country:US
Mailing Address - Phone:253-833-9049
Mailing Address - Fax:
Practice Address - Street 1:6839 FORT DENT WAY
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2502
Practice Address - Country:US
Practice Address - Phone:206-812-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-23
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU60960821133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist