Provider Demographics
NPI:1932570827
Name:MARAVE, FIONNA F (RDN)
Entity type:Individual
Prefix:MRS
First Name:FIONNA
Middle Name:F
Last Name:MARAVE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:FIONNA
Other - Middle Name:
Other - Last Name:IBALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:1124 COLUMBIA ST STE 400
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2053
Practice Address - Country:US
Practice Address - Phone:206-215-2090
Practice Address - Fax:206-215-3099
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-17
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60968808133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2153903Medicaid