Provider Demographics
NPI:1225658941
Name:STEVENSON, NIKKI SPRING (RDN)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:SPRING
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:SPRING
Other - Last Name:NYGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:18411 120TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-7254
Mailing Address - Country:US
Mailing Address - Phone:206-799-7273
Mailing Address - Fax:
Practice Address - Street 1:18411 120TH AVE SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-7254
Practice Address - Country:US
Practice Address - Phone:206-799-7273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA968290133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered