Provider Demographics
NPI:1740512607
Name:WIEST, SHARLA ANN (RD, CD)
Entity type:Individual
Prefix:MRS
First Name:SHARLA
Middle Name:ANN
Last Name:WIEST
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:MISS
Other - First Name:SHARLA
Other - Middle Name:ANN
Other - Last Name:BIGHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:527 WINDFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98674-7216
Mailing Address - Country:US
Mailing Address - Phone:360-225-0152
Mailing Address - Fax:
Practice Address - Street 1:400 NE MOTHER JOSEPH PL
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3200
Practice Address - Country:US
Practice Address - Phone:360-514-2559
Practice Address - Fax:360-514-3590
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001263133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered