Provider Demographics
NPI:1225348642
Name:STAMM, SIERRA JENEAL (RD CD)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:JENEAL
Last Name:STAMM
Suffix:
Gender:F
Credentials:RD CD
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Mailing Address - Street 1:13619 MUKILTEO SPEEDWAY
Mailing Address - Street 2:STE D5 #172
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-1626
Mailing Address - Country:US
Mailing Address - Phone:425-210-8016
Mailing Address - Fax:
Practice Address - Street 1:4208 198TH ST SW
Practice Address - Street 2:101B
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6735
Practice Address - Country:US
Practice Address - Phone:425-210-8016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WADI 60058984133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA964668OtherCOMMISSION ON DIETETIC REGISTRATION
WADI 60058984OtherWASHINGTON STATE DEPARTMENT OF HEALTH DIETICIAN CERTIFICATION