Provider Demographics
NPI:1235220393
Name:STAGGER, NINA FAYE (RD,LD)
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:FAYE
Last Name:STAGGER
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:MS
Other - First Name:NINA
Other - Middle Name:C
Other - Last Name:STAGGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2803 DORSET DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-4212
Mailing Address - Country:US
Mailing Address - Phone:501-224-8807
Mailing Address - Fax:
Practice Address - Street 1:2200 FORT ROOTS DR # 120/NLR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-2881
Practice Address - Fax:501-257-2879
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R348038133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered