Provider Demographics
NPI:1992528871
Name:MARTIN, EDA V (RDN, MS, CD)
Entity type:Individual
Prefix:
First Name:EDA
Middle Name:V
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RDN, MS, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4228 249TH CT SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-5792
Mailing Address - Country:US
Mailing Address - Phone:310-308-4463
Mailing Address - Fax:
Practice Address - Street 1:4228 249TH CT SE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98029-5792
Practice Address - Country:US
Practice Address - Phone:310-308-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
913851133V00000X
WA913851133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist