Individual
CHERYL LEA COSTOMIRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED DIETITIAN
Contact information
Practice address
1415 E KINCAID ST, MOUNT VERNON, WA 98274-4126
(360) 814-8329
(360) 814-5515
Mailing address
1415 E KINCAID ST, MOUNT VERNON, WA 98274-4126
(360) 814-5515
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D100000443
WA
Other
Enumeration date
03/28/2022
Last updated
03/28/2022
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