Provider Demographics
NPI:1407441215
Name:SIM, ELAINE (RD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:SIM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17243 NW WIDGI CREEK CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-8147
Mailing Address - Country:US
Mailing Address - Phone:503-547-4106
Mailing Address - Fax:
Practice Address - Street 1:17243 NW WIDGI CREEK CT
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-8147
Practice Address - Country:US
Practice Address - Phone:503-547-4106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered