Provider Demographics
NPI:1134686348
Name:ECKER, MARIAH CHRISTINE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:MARIAH
Middle Name:CHRISTINE
Last Name:ECKER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5152 HAUAALA ROAD
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-2015
Mailing Address - Country:US
Mailing Address - Phone:808-369-9100
Mailing Address - Fax:855-670-0422
Practice Address - Street 1:3-3295 KUHIO HWY
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1040
Practice Address - Country:US
Practice Address - Phone:808-369-9100
Practice Address - Fax:855-670-0422
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI210-LD133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered