Provider Demographics
NPI:1174807549
Name:PATEL, BHAVINI (CN)
Entity type:Individual
Prefix:
First Name:BHAVINI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9209 124TH AVE NE APT L606
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5888
Mailing Address - Country:US
Mailing Address - Phone:425-301-8135
Mailing Address - Fax:
Practice Address - Street 1:9209 124TH AVE NE APT L606
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5888
Practice Address - Country:US
Practice Address - Phone:425-301-8135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU 60083349133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist