Provider Demographics
NPI:1326686213
Name:COOK, SIERRA GRAINGER (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:GRAINGER
Last Name:COOK
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:DANIELLE
Other - Last Name:GRAINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 STONY BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-4654
Mailing Address - Country:US
Mailing Address - Phone:843-693-2019
Mailing Address - Fax:
Practice Address - Street 1:100 BREWSTER BLVD
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2575
Practice Address - Country:US
Practice Address - Phone:910-450-4416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005804133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered