Provider Demographics
NPI:1437103959
Name:SICKELS, ROBIN J (RDN LRD)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:J
Last Name:SICKELS
Suffix:
Gender:F
Credentials:RDN LRD
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:IVERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3415 20TH AVE S APT 108
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5762
Mailing Address - Country:US
Mailing Address - Phone:701-781-5165
Mailing Address - Fax:
Practice Address - Street 1:3415 20TH AVE S APT 108
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5762
Practice Address - Country:US
Practice Address - Phone:701-781-5165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND610133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND51127Medicaid
ND51127Medicaid