Individual
SIMONE VICTORIA HAGERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CD
Contact information
Practice address
33431 13TH PL S, FEDERAL WAY, WA 98003-6357
(206) 296-9877
Mailing address
2311 S 10TH ST, TACOMA, WA 98405-3023
(253) 272-1301
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DI00001068
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8270035
—
WA
01
—
849303
LISCENSE NUMBER
WA
01
—
DI00001068
LISCENSE NUMBER
WA
Enumeration date
11/16/2006
Last updated
07/08/2007
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