Provider Demographics
NPI:1972241768
Name:METCALFE, MERRI CAITLIN (RDN, CSSD)
Entity type:Individual
Prefix:
First Name:MERRI
Middle Name:CAITLIN
Last Name:METCALFE
Suffix:
Gender:F
Credentials:RDN, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16882 NILSON RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-4771
Mailing Address - Country:US
Mailing Address - Phone:619-818-9138
Mailing Address - Fax:
Practice Address - Street 1:111 TUMWATER BLVD SE STE C213
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6400
Practice Address - Country:US
Practice Address - Phone:360-706-2674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60928495133V00000X
WA1060063133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered