Evergreen Pediatric Nutrition LLC

Primary specialty

Pediatric Nutrition Registered DietitianTaxonomy code 133VN1004X

Legal business name

EVERGREEN PEDIATRIC NUTRITION LLC

Practice address

2440 Ferndale PL NE
Renton, WA 98056-8374

Phone

(425) 835-2256

NPI assigned

May 29, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mari Mazon, RDN

Title

Business Owner

Phone

(425) 835-2256

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1780012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780012800000",
    "number": "1124950845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2440 FERNDALE PL NE",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980568374",
            "telephone_number": "425-835-2256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2440 FERNDALE PL NE",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980568374",
            "telephone_number": "425-835-2256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PEDIATRIC NUTRITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-05-29",
        "last_updated": "2026-05-29",
        "certification_date": "2026-05-29",
        "status": "A",
        "authorized_official_last_name": "MAZON",
        "authorized_official_first_name": "MARI",
        "authorized_official_title_or_position": "BUSINESS OWNER",
        "authorized_official_telephone_number": "425-835-2256",
        "authorized_official_credential": "RDN"
    },
    "taxonomies": [
        {
            "code": "133VN1004X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shanae Laquich Evans, MS, LMHCA
• Nancy J Eveleth, LMHC
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• Evergreen at Talbot Road, L.L.C.
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• Everlasting Smiles 4 U
• Amanda Everly, LMHC
• Martha Ewer
• Express Care TX PLLC

• Pediatric Nutrition Registered Dietitian in Renton, WA
• Providers in Renton, WA by specialty
• Pediatric Nutrition Registered Dietitian in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.