Provider Demographics
NPI:1386161990
Name:MILLER, LANI KATE (RDN)
Entity type:Individual
Prefix:MRS
First Name:LANI
Middle Name:KATE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MS
Other - First Name:LANI
Other - Middle Name:KATE
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:12 BELLWETHER WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2914
Mailing Address - Country:US
Mailing Address - Phone:360-739-1278
Mailing Address - Fax:425-610-9258
Practice Address - Street 1:12 BELLWETHER WAY STE 223
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2914
Practice Address - Country:US
Practice Address - Phone:360-739-1278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60738912133V00000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2138814Medicaid
86057276OtherCOMMISSION ON DIETETIC REGISTRATION
WADI60738912OtherDIETITIAN CERTIFICATION