Provider Demographics
NPI:1538506217
Name:SIEKIERSKI, DANIELLE LYNN (RD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LYNN
Last Name:SIEKIERSKI
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 1:644 MASSACHUSETTS AVE NE APT 303
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-6069
Mailing Address - Country:US
Mailing Address - Phone:704-996-5355
Mailing Address - Fax:
Practice Address - Street 1:6136 BRANDON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2610
Practice Address - Country:US
Practice Address - Phone:703-866-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1079293133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered