Active NPI
Brooke Erickson
- Nutritionist
- Bellevue, WA
National Provider Identifier
1073978565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- 603550453
- Practice address
- 11636 SE 5TH St Ste 100
Bellevue, WA 98005-3527 - Phone
- (425) 395-4638
- NPI assigned
- Dec 28, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 603550453 | WA | Primary |
Addresses
Primary practice location
11636 SE 5TH St Ste 100
Bellevue, WA 98005-3527
Mailing address
1420 NW Gilman Blvd # 2237
Issaquah, WA 98027-5394
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 |
|---|---|---|---|
| 603550453 | WA | MD | Nutritionist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourishthrive, LLC | Nutritionist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Nutritionist
- Issaquah, WA
- NPI 1447609482
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1451260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521763200000",
"number": "1073978565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1420 NW GILMAN BLVD # 2237",
"city": "ISSAQUAH",
"state": "WA",
"postal_code": "980275394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11636 SE 5TH ST STE 100",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "980053527",
"telephone_number": "425-395-4638"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERICKSON",
"first_name": "BROOKE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-12-28",
"last_updated": "2018-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "WA",
"license": "603550453",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellevue, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.