Provider Demographics
NPI:1598499832
Name:SOIREZ, NICHOLAS (RD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:SOIREZ
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W PACIFIC AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-4320
Mailing Address - Country:US
Mailing Address - Phone:832-405-5213
Mailing Address - Fax:
Practice Address - Street 1:304 W PACIFIC AVE STE 210
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-4320
Practice Address - Country:US
Practice Address - Phone:832-405-5213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA86293539133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered