Provider Demographics
NPI:1285094425
Name:DEVERS, THERESA ANNE (DIETICIAN, CHC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANNE
Last Name:DEVERS
Suffix:
Gender:F
Credentials:DIETICIAN, CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14116 50TH AVE E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98446-4163
Mailing Address - Country:US
Mailing Address - Phone:253-318-8110
Mailing Address - Fax:253-531-1159
Practice Address - Street 1:14116 50TH AVE E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98446-4163
Practice Address - Country:US
Practice Address - Phone:253-318-8110
Practice Address - Fax:253-531-1159
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603291211133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education