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Individual
MARIAM GEDEVANISHVILI
Active
Individual
MARIAM GEDEVANISHVILI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
—
—
2255A2300X
Athletic Trainer
—
—
225700000X
Massage Therapist
Primary
MA60058598
WA
Other
Enumeration date
12/21/2006
Last updated
06/11/2012
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