Provider Demographics
NPI:1700245222
Name:SIKKEMA, SUANNE FAITH (MS, CNS)
Entity Type:Individual
Prefix:
First Name:SUANNE
Middle Name:FAITH
Last Name:SIKKEMA
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91014
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99509-1014
Mailing Address - Country:US
Mailing Address - Phone:907-830-9877
Mailing Address - Fax:
Practice Address - Street 1:610 W 2ND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2151
Practice Address - Country:US
Practice Address - Phone:907-830-9877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist