Provider Demographics
NPI:1336698455
Name:ELIASON, NICHOLE E (NUTRITIONAL THERAPY)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:E
Last Name:ELIASON
Suffix:
Gender:F
Credentials:NUTRITIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LILLY RD NE
Mailing Address - Street 2:BLDG B
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-754-9409
Mailing Address - Fax:360-438-6760
Practice Address - Street 1:200 LILLY RD NE
Practice Address - Street 2:BLDG B
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-754-9409
Practice Address - Fax:360-438-6760
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist