Active NPI
Mara Andrus
- Registered Dietitian
- Vashon, WA
National Provider Identifier
1669899217
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DI 00001645
- Practice address
- 10333 SW 116TH St
Vashon, WA 98070-3080 - Phone
- (206) 819-5100
- NPI assigned
- Mar 20, 2014
- 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 | DI 00001645 | WA | Primary |
Addresses
Primary practice location
10333 SW 116TH St
Vashon, WA 98070-3080
Mailing address
10333 SW 116TH St
Vashon, WA 98070-3080
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 16210 | Other | AMERICAN DIETETIC ASSOCIATION | |
| DI 00001645 | Other | WA | STATE DIETITIAN CERTIFICATION |
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 |
|---|---|---|---|
| DI 00001645 | WA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395273600000",
"number": "1669899217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10333 SW 116TH ST",
"city": "VASHON",
"state": "WA",
"postal_code": "980703080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10333 SW 116TH ST",
"city": "VASHON",
"state": "WA",
"postal_code": "980703080",
"telephone_number": "206-819-5100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDRUS",
"first_name": "MARA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-03-20",
"last_updated": "2014-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WA",
"license": "DI 00001645",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN DIETETIC ASSOCIATION",
"identifier": "16210",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE DIETITIAN CERTIFICATION",
"identifier": "DI 00001645",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vashon, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.