Provider Demographics
NPI:1588761381
Name:VERBOVSKI, MARY JONES (MS, RDN, CSO, CD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JONES
Last Name:VERBOVSKI
Suffix:
Gender:F
Credentials:MS, RDN, CSO, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 SAND POINT WAY NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3901
Mailing Address - Country:US
Mailing Address - Phone:206-987-2396
Mailing Address - Fax:206-987-5087
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:M/S W3726
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-2396
Practice Address - Fax:206-987-5087
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001785133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAIN PROCESSMedicaid