Organization
LEILA DAVIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEILA ALEXANDRA DAVIS NDTR (NUTRITION AND DIET TECHNICINA)
(870) 224-5492
Entity
Organization
Contact information
Practice address
17806 80TH AVE NE, KENMORE, WA 98028-1806
(870) 224-5492
Mailing address
17806 80TH AVE NE, KENMORE, WA 98028-1806
(870) 224-5492
Taxonomy
Speciality
Code
Description
License number
State
136A00000X
Registered Dietetic Technician
Primary
1057724
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1057724
COMMISSION ON DIETETIC REGISTRATION
WA
Enumeration date
02/08/2016
Last updated
02/08/2016
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