Individual
TIMOTHY P HERAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDN, CGD, CD
Contact information
Practice address
1141 BEACH DR E, PORT ORCHARD, WA 98366-4937
(360) 895-4668
Mailing address
1141 BEACH DR E, PORT ORCHARD, WA 98366-4937
(360) 895-4668
Taxonomy
Speciality
Code
Description
License number
State
133VN1101X
Gerontological Nutrition Registered Dietitian
Primary
843377
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DIII604031181
CERTIFIED DIETITIAN
WA
Enumeration date
10/22/2019
Last updated
10/22/2019
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