Individual
AMANDA KAY BULLAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
18495 BALLINGER WAY NE, LAKE FOREST PARK, WA 98155-4238
(541) 647-9185
Mailing address
18495 BALLINGER WAY NE, LAKE FOREST PARK, WA 98155-4238
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DI 60133367
WA
Other
Enumeration date
07/06/2013
Last updated
07/06/2013
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