Provider Demographics
NPI:1417572579
Name:JUPE, NIKKI (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:JUPE
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 5TH ST APT 27
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-2291
Mailing Address - Country:US
Mailing Address - Phone:254-366-9204
Mailing Address - Fax:
Practice Address - Street 1:1928 5TH ST APT 27
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-2291
Practice Address - Country:US
Practice Address - Phone:254-366-9204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-14
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83422133V00000X
ORLD-D-10182602133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered