JACIE L VAN BLARICOM


Address: 411 Fortuyn Rd, Grand Coulee, WA 99133-8718
Phone: 5096331753

JACIE L VAN BLARICOM (NPI# 1780080515) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1780080515
Entity Type Individual
Full Name JACIE L VAN BLARICOM
Credential DI
Practice Address 411 Fortuyn Rd
Grand Coulee
WA 99133-8718
Practice Telephone 5096331753
Practice Fax Number 5096331933
Mailing Telephone 5096331753
Mailing Fax Number 5096331933
Enumeration Date 2014-11-05
Last Update Date 2018-03-13
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 133V00000X Dietitian, Registered DI60513122 WA Dietary & Nutritional Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
WA 2040919 05

Office Location

Street Address 411 FORTUYN RD
City GRAND COULEE
State WA
Zip Code 99133-8718

Providers in the same location

NPI Name Taxonomy Address Enumeration
1205838703 David Martin Brown Nurse Anesthetist, Certified Registered 411 Fortuyn Rd, Coulee Community Hospital, Grand Coulee, WA 99133-8718 2005-08-15
1144725664 Amy Anne Haden Registered Nurse 411 Fortuyn Rd, Grand Coulee, WA 99133-8718 2018-03-27
1639689748 Cheney Owl Pharmacy Inc Pharmacy 411 Fortuyn Rd, Grand Coulee, WA 99133-8718 2017-10-03
1982050779 Leah G Kobes Family Medicine 411 Fortuyn Rd, Grand Coulee, WA 99133-8718 2016-05-11
1003274614 Anna Hardesty Physical Therapist 411 Fortuyn Rd, Grand Coulee, WA 99133-8718 2016-02-10
1740653807 Kathleen Christine Henry Physician Assistant 411 Fortuyn Rd, Grand Coulee, WA 99133-8718 2015-11-10
1255709614 Melissa Stanley Registered Nurse 411 Fortuyn Rd, Grand Coulee, WA 99133-8718 2015-09-02
1134516933 Jennifer Knox Family Medicine 411 Fortuyn Rd, Grand Coulee, WA 99133-8718 2015-04-20
1538589023 Marilynn Holman Psychiatry & Neurology 411 Fortuyn Rd, Grand Coulee, WA 99133-8718 2014-04-23
1376962852 Adam Fields Mcconnell Family Medicine 411 Fortuyn Rd, Grand Coulee, WA 99133-8718 2014-04-10
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1134754468 Alexander Chhun Tor Pharmacist 320 Midway Ave., Grand Coulee, WA 99133 2020-03-06
1093081333 Cara Turner Pharmacist 320 Midway Avenue, Grand Coulee, WA 99133 2012-03-30
1922312479 Elizabeth Hsu Internal Medicine 411 Fortuyn Road, Grand Coulee, WA 99133 2010-07-27
1295909448 Jg Pepperd Dc Pllc Chiropractor 400 Burdin Blvd, Grand Coulee, WA 99133 2008-04-18
1629171616 Galen Neal Schmidt Optometrist 407 Burdin Blvd., Grand Coulee, WA 99133 2006-09-06
1841230489 Lesa Eiffert Counselor 322 Fortuyn Rd, Grand Coulee, WA 99133 2006-06-08
1578919700 Real Vision, Inc Optometrist 407 Burdin Blvd, Grand Coulee, WA 99133 2016-05-06
1255770020 Kyle M. Gillespie, O.d., Ltd. Optometrist 407 Burdin Blvd, Grand Coulee, WA 99133 2013-06-14
1568716975 Kai Scott Physical Therapist 321 Burdin Boulevard, Grand Coulee, WA 99133 2012-11-07
1972657328 Kelly J Prather Physical Therapist 321 Burdin Blvd, Grand Coulee Physical Therapy, Grand Coulee, WA 99133 2007-01-23
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Taxonomy Information

Taxonomy Code 133V00000X
Grouping Dietary & Nutritional Service Providers
Classification Dietitian, Registered

Taxonomy Definition

A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration.
Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1407199714 Grace Ruth Heaton Dietitian, Registered 411 Fortuyn Rd, Grand Coulee, WA 99133-8718 2013-04-04

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1275134256 Hannah Baillie Dietitian, Registered 11651 Se 58th St, Bellevue, WA 98006-3722 2020-11-05
1629679949 Renewtrition, LLC Dietitian, Registered 4239 Evanston Ave N, Seattle, WA 98103-7206 2020-11-03
1144821620 Sydney Marie Carroll Dietitian, Registered 1818 E Mercer St Ste 103, Seattle, WA 98112-4689 2020-11-03
1598365876 Michelle Irene Howe Dietitian, Registered 14808 23rd Ave Ne, Arlington, WA 98223-9701 2020-10-27
1306445150 Healthy Bodies Nutrition Dietitian, Registered 12808 E Apache Pass Rd, Spokane, WA 99206-9309 2020-10-22
1487253621 Ellen Kim Cho Dietitian, Registered 530 Rosewood Dr Sw, Olympia, WA 98502-2686 2020-10-20
1427656925 Jeannie Lise Belle Castell Dietitian, Registered 4229 Glen Terra Dr Se, Olympia, WA 98503-7165 2020-10-15
1104424845 Mariia Byelykh Dietitian, Registered 20113 3rd Ave Se, Bothell, WA 98012-4521 2020-10-14
1629676499 Shelley Lea Barnhart Dietitian, Registered 24315 Se 196th St, Maple Valley, WA 98038-8975 2020-10-14
1235737115 Beth Ann Smith Dietitian, Registered 130 Teal Ln, Eastsound, WA 98245-5077 2020-10-13
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Competitor

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City GRAND COULEE
Zip Code 99133

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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