Provider Demographics
NPI:1154094134
Name:PAPPALARDO, SIMONE R (RD)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:R
Last Name:PAPPALARDO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4928 N CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-5418
Mailing Address - Country:US
Mailing Address - Phone:509-822-8830
Mailing Address - Fax:
Practice Address - Street 1:15918 E EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1815
Practice Address - Country:US
Practice Address - Phone:509-924-1826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI61109377133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered