Jacie L Van Blaricom, DI | |
411 Fortuyn Rd, Grand Coulee, WA 99133-8718 | |
(509) 633-1753 | |
(509) 633-1933 |
Full Name | Jacie L Van Blaricom |
---|---|
Gender | Female |
Speciality | Dietitian, Registered |
Location | 411 Fortuyn Rd, Grand Coulee, Washington |
Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1780080515 | NPI | - | NPPES |
2040919 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
133V00000X | Dietitian, Registered | DI60513122 (Washington) | Primary |
Mailing Address | Practice Location Address |
---|---|
Jacie L Van Blaricom, DI 411 Fortuyn Rd, Grand Coulee, WA 99133-8718 Ph: (509) 633-1753 | Jacie L Van Blaricom, DI 411 Fortuyn Rd, Grand Coulee, WA 99133-8718 Ph: (509) 633-1753 |
Alejandro Troncoso, RD Dietitian Medicare: Medicare Enrolled Practice Location: 411 Fortuyn Rd, Grand Coulee, WA 99133 Phone: 509-633-1753 | |
Grace Ruth Heaton, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 411 Fortuyn Rd, Grand Coulee, WA 99133 Phone: 509-633-6373 |