Provider Demographics
NPI:1962740233
Name:ORPHAN, MIKAYLA MARIE (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:MIKAYLA
Middle Name:MARIE
Last Name:ORPHAN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:MARIE
Other - Last Name:FITZPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6415 155TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-3608
Mailing Address - Country:US
Mailing Address - Phone:253-279-5087
Mailing Address - Fax:
Practice Address - Street 1:6415 155TH AVE E
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-3608
Practice Address - Country:US
Practice Address - Phone:253-279-5087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist