Provider Demographics
NPI:1588910665
Name:HOFFMAN, GRETCHEN LAVEDA (RD)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:LAVEDA
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:LAVEDA
Other - Last Name:BROKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34509 9TH AVE S
Mailing Address - Street 2:STE 310
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6700
Mailing Address - Country:US
Mailing Address - Phone:253-944-6544
Mailing Address - Fax:253-944-6542
Practice Address - Street 1:34509 9TH AVE S
Practice Address - Street 2:STE 310
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6700
Practice Address - Country:US
Practice Address - Phone:253-944-6544
Practice Address - Fax:253-944-6542
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60044484133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered