Active NPI
Mary Angelee Limocon Brown, RDN
- Registered Dietitian
- Port Hadlock, WA
National Provider Identifier
1508614751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DI61524678
- Practice address
- 90 Kem St
Port Hadlock, WA 98339-9534 - Phone
- (360) 215-0735
- NPI assigned
- May 10, 2024
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DI61524678 | WA | Primary |
Addresses
Primary practice location
90 Kem St
Port Hadlock, WA 98339-9534
Mailing address
PO Box 374
Port Hadlock, WA 98339-0374
Phone (360) 215-0735
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 |
|---|---|---|---|
| DI61524678 | WA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715299200000",
"number": "1508614751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 374",
"city": "PORT HADLOCK",
"state": "WA",
"postal_code": "983390374",
"telephone_number": "360-215-0735",
"fax_number": "000-000-0000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 KEM ST",
"city": "PORT HADLOCK",
"state": "WA",
"postal_code": "983399534",
"telephone_number": "360-215-0735"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROWN",
"first_name": "MARY ANGELEE",
"middle_name": "LIMOCON",
"name_prefix": "Mrs.",
"credential": "RDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-05-10",
"last_updated": "2024-05-10",
"certification_date": "2024-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WA",
"license": "DI61524678",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Hadlock, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.