Provider Demographics
NPI:1053614651
Name:FERGUSSON WASHBURN, SHEENA CHRISTINE (RDN, CD)
Entity type:Individual
Prefix:
First Name:SHEENA
Middle Name:CHRISTINE
Last Name:FERGUSSON WASHBURN
Suffix:
Gender:F
Credentials:RDN, CD
Other - Prefix:
Other - First Name:SHENA
Other - Middle Name:
Other - Last Name:FERGUSSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1700 WESTLAKE AVE N
Mailing Address - Street 2:STE-700
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 WESTLAKE AVE N STE 700
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3097
Practice Address - Country:US
Practice Address - Phone:206-283-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1010063133V00000X
WA60185501133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA26-4033540OtherEMPLOYER IDENTIFICATION NUMBER