Organization
SAGE WISDOM NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOPHIA L TASLER BSN (PROVIDER/OWNER)
(253) 951-4820
Entity
Organization
Contact information
Practice address
1019 PACIFIC AVE, SUITE 801, TACOMA, WA 98402-4443
(253) 254-6945
Mailing address
PO BOX 97115, LAKEWOOD, WA 98497-0115
(253) 588-7911
(253) 365-6299
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
DI60417979
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DI60417979
LICENSE NO
WA
Enumeration date
07/27/2015
Last updated
07/27/2015
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