Dynamic Nutrition NW LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

DYNAMIC NUTRITION NW LLC

Doing business as

Dynamic Nutrition NW
Dynamic Nutrition NW LLC

Practice address

5811 187TH Ave SE
Issaquah, WA 98027-8620

Phone

(425) 470-3458

Fax

(425) 372-7941

NPI assigned

Mar 10, 2021

Last updated

Mar 10, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Evangelia Facchine, RD, CDNPI 1255995973

Title

Owner

Phone

(732) 986-2633

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Dynamic Nutrition NW Doing business as
• Dynamic Nutrition NW LLC Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Evangelia Nicole Facchine, RD CD

  • Registered Dietitian
  • Issaquah, WA
  • NPI 1255995973

  Dietitian, Registered

  NPD Authorized official

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

{
    "created_epoch": "1615334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615334400000",
    "number": "1780269902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5811 187TH AVE SE",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980278620",
            "telephone_number": "425-470-3458",
            "fax_number": "425-372-7941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5811 187TH AVE SE",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980278620",
            "telephone_number": "425-470-3458",
            "fax_number": "425-372-7941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC NUTRITION NW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-10",
        "last_updated": "2021-03-10",
        "certification_date": "2021-03-10",
        "status": "A",
        "authorized_official_last_name": "FACCHINE",
        "authorized_official_first_name": "EVANGELIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-986-2633",
        "authorized_official_credential": "RD, CD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1255995973",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dynamic Nutrition NW",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dynamic Nutrition NW LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mylien Thi Duong, PH.D.
• Daniel T Duryea, DPT
• Dynacare Northwest Inc (Issaquah RRL)
• Dynacare Northwest Inc. (Issaquah Stat Lab)
• Dynacare Northwest, Inc
• E. McKay Tingey DDS Ms PC (Tingey Orthodontics)
• E. Polsky DDS & B. Virk DMD MSD, PLLC (Egger Orthodontics)
• Alexandria C. Easter, N.D.
• Eastside Audiology & Hearing Services PS
• Eastside Children's Therapy

• Registered Dietitian in Issaquah, WA
• Providers in Issaquah, WA by specialty
• Registered Dietitian in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2021; 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.