Provider Demographics
NPI:1972769651
Name:WETMORE, VERNA R (RD, CD, LD)
Entity type:Individual
Prefix:
First Name:VERNA
Middle Name:R
Last Name:WETMORE
Suffix:
Gender:F
Credentials:RD, CD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 E 2ND AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2207
Mailing Address - Country:US
Mailing Address - Phone:509-744-9891
Mailing Address - Fax:509-742-3495
Practice Address - Street 1:1011 E 2ND AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2207
Practice Address - Country:US
Practice Address - Phone:509-744-9891
Practice Address - Fax:509-742-3495
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000903133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8511545Medicaid