Active NPI
Stacy Lueck, RD
- Registered Dietitian
- Spokane Valley, WA
National Provider Identifier
1467613661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- D100001230
- 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
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 | 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D100001230 | Other | WA | WA CERTIFICATION NUMBER |
| 9051731 | Medicaid | WA | |
| 00851672 | Other | WA | ADA NUMBER |
| 8261471 | Other | WA | PROVIDER 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
| License | State | Type | Specialty |
|---|---|---|---|
| D100001230 | WA | MD | Registered 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.