Provider Demographics
NPI:1265471668
Name:SIEVERS, NICOLE (RD CDE)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:SIEVERS
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4567 HAUAALA RD
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1810
Mailing Address - Country:US
Mailing Address - Phone:808-634-9379
Mailing Address - Fax:
Practice Address - Street 1:4567 HAUAALA RD
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1810
Practice Address - Country:US
Practice Address - Phone:808-634-9379
Practice Address - Fax:808-468-9976
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00928138133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered