# LEILA DAVIS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295193084
- **Authorized official:** LEILA ALEXANDRA DAVIS NDTR (NUTRITION AND DIET TECHNICINA)
- **Authorized official phone:** (870) 224-5492

## Contact information

- **Practice address:** 17806 80TH AVE NE, KENMORE, WA 98028-1806
- **Practice address phone:** (870) 224-5492
- **Mailing address:** 17806 80TH AVE NE, KENMORE, WA 98028-1806
- **Mailing address phone:** (870) 224-5492

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 136A00000X | Registered Dietetic Technician | 1057724 | AR | Yes |

## Other

- **Enumeration date:** 02/08/2016
- **Last updated:** 02/08/2016