Provider Demographics
NPI:1306576319
Name:ENDOF-HORN, ALEXA (RD)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:ENDOF-HORN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:
Other - Last Name:KAFTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:15028 180TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15028 180TH AVE SE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1121
Practice Address - Country:US
Practice Address - Phone:425-760-5315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60631769133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered