Provider Demographics
NPI:1043860927
Name:CHRISTOPHER, CASSANDRA ROSE (RDN)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:ROSE
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MISS
Other - First Name:CASSANDRA
Other - Middle Name:ROSE
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24030 FIRDALE AVE
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-6522
Mailing Address - Country:US
Mailing Address - Phone:425-231-3435
Mailing Address - Fax:
Practice Address - Street 1:35 MILLER AVE STE 273
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1903
Practice Address - Country:US
Practice Address - Phone:415-302-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered