Provider Demographics
NPI:1437257128
Name:SIEMIACZKO, ANGELA DAWN (MS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:DAWN
Last Name:SIEMIACZKO
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:DAWN
Other - Last Name:SIEMIACZKO-TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:69 RIVERVIEW DRIVE
Mailing Address - Street 2:PO BOX 392
Mailing Address - City:CHARLTON HEIGHTS
Mailing Address - State:WV
Mailing Address - Zip Code:25040-0392
Mailing Address - Country:US
Mailing Address - Phone:304-549-4810
Mailing Address - Fax:304-779-2555
Practice Address - Street 1:69 RIVERVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:CHARLTON HEIGHTS
Practice Address - State:WV
Practice Address - Zip Code:25040-0392
Practice Address - Country:US
Practice Address - Phone:304-549-4810
Practice Address - Fax:304-779-2555
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV590133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered