Individual provider Active NPI

Stacy Lueck, RD

  • Registered Dietitian
  • Spokane Valley, WA
National Provider Identifier
1467613661
Registry record updated Jun 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
D100001230 Issued in WA
Practice address
11703 E Sprague Ave Ste C3
Spokane Valley, WA 99206-6129
Phone
(509) 921-6560
Fax
(509) 921-6551
NPI assigned
Jun 19, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X D100001230 WA Primary

Addresses

Primary practice location

11703 E Sprague Ave Ste C3
Spokane Valley, WA 99206-6129

Mailing address

4003 E Funk Ave
Spokane, WA 99223-5356
Phone (509) 921-6560

Other identifiers 4

IdentifierTypeStateIssuer
D100001230OtherWAWA CERTIFICATION NUMBER
9051731MedicaidWA
00851672OtherWAADA NUMBER
8261471OtherWAPROVIDER NUMBER

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

LicenseStateTypeSpecialty
D100001230WAMDRegistered Dietitian

NPI Registry JSON

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

{
    "created_epoch": "1213833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213833600000",
    "number": "1467613661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4003 E FUNK AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992235356",
            "telephone_number": "509-921-6560",
            "fax_number": "509-921-6551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11703 E SPRAGUE AVE STE C3",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992066129",
            "telephone_number": "509-921-6560",
            "fax_number": "509-921-6551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUECK",
        "first_name": "STACY",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-19",
        "last_updated": "2008-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WA",
            "license": "D100001230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA CERTIFICATION NUMBER",
            "identifier": "D100001230",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9051731",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADA NUMBER",
            "identifier": "00851672",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "8261471",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane Valley, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 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.

Verify at the official NPI Registry.