Individual provider Active NPI

Laura Elizabeth Fears

  • Registered Dietitian
  • Lynnwood, WA
National Provider Identifier
1750982963
Registry record updated Nov 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Practice address
19217 36TH Ave W Ste 102
Lynnwood, WA 98036-5751
Phone
(405) 670-9991
Fax
(425) 670-9995
NPI assigned
Nov 4, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2020

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 Primary

Addresses

Primary practice location

19217 36TH Ave W Ste 102
Lynnwood, WA 98036-5751

Mailing address

11711 NE 12TH St Ste 3a
Bellevue, WA 98005-2461
Phone (425) 670-9991

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210113002510 WA Practitioner - Registered Dietitian Or Nutrition Professional 2961815816 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The Polyclinic PLLC CurrentSince May 25, 2022 Accepting new patients
The Polyclinic PLLC Current Accepting new patients
The Polyclinic PLLC Past Accepting new patients

Locations

1145 Broadway
Seattle, WA 98122

904 7th Ave
Seattle, WA 98104
Phone (206) 223-6487

Organizations & group practices 3

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": "1604448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604448000000",
    "number": "1750982963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11711 NE 12TH ST STE 3A",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980052461",
            "telephone_number": "425-670-9991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19217 36TH AVE W STE 102",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980365751",
            "telephone_number": "405-670-9991",
            "fax_number": "425-670-9995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEARS",
        "first_name": "LAURA",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-04",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynnwood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.