Provider Demographics
NPI:1265752018
Name:WILLIAMSON, NILA NORINE (MPH, RD, CD, IBCLC)
Entity type:Individual
Prefix:
First Name:NILA
Middle Name:NORINE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MPH, RD, CD, IBCLC
Other - Prefix:
Other - First Name:NILA
Other - Middle Name:NORINE
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:323 MAPLE PARK AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2360
Mailing Address - Country:US
Mailing Address - Phone:360-449-6791
Mailing Address - Fax:
Practice Address - Street 1:3434 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5175
Practice Address - Country:US
Practice Address - Phone:360-413-8470
Practice Address - Fax:360-419-5660
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-15637174N00000X
WADI 60043903133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No174N00000XOther Service ProvidersLactation Consultant, Non-RN