Active NPI
Lile D Ellefsen, RD
- Registered Dietitian
- Kirkland, WA
National Provider Identifier
1003067133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DI00000922
- Practice address
- 13008 NE 125TH Way
Kirkland, WA 98034-7726 - Phone
- (425) 814-8443
- NPI assigned
- Oct 7, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DI00000922 | WA | Primary |
Addresses
Primary practice location
13008 NE 125TH Way
Kirkland, WA 98034-7726
Mailing address
12906 NE 128TH PL
Kirkland, WA 98034-7901
Phone (425) 823-7764
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DI00000922 | WA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Proactive Nutrition | Dietitian, Registered | Past | Accepting new patients |
| Proactive Nutrition, LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinic/Center
- Kirkland, WA
- NPI 1780831917
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223337600000",
"number": "1003067133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12906 NE 128TH PL",
"city": "KIRKLAND",
"state": "WA",
"postal_code": "980347901",
"telephone_number": "425-823-7764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13008 NE 125TH WAY",
"city": "KIRKLAND",
"state": "WA",
"postal_code": "980347726",
"telephone_number": "425-814-8443"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLEFSEN",
"first_name": "LILE",
"middle_name": "D",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-07",
"last_updated": "2008-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WA",
"license": "DI00000922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kirkland, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.