Provider Demographics
NPI:1487242673
Name:MEYER, JUSTINE VIOLET (RD)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:VIOLET
Last Name:MEYER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 E EVERGREEN BLVD UNIT 399
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-4323
Mailing Address - Country:US
Mailing Address - Phone:805-637-2696
Mailing Address - Fax:
Practice Address - Street 1:5565 E EVERGREEN BLVD
Practice Address - Street 2:UNIT 3102
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-6672
Practice Address - Country:US
Practice Address - Phone:805-637-2696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10217863133V00000X
WADI61205677133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500825706Medicaid
WA2297586Medicaid