Provider Demographics
NPI:1831589548
Name:SIMMER, CAROL (RDN)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:SIMMER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:SIMMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:315 HALLECK ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4013
Mailing Address - Country:US
Mailing Address - Phone:360-733-4030
Mailing Address - Fax:360-647-7952
Practice Address - Street 1:315 HALLECK ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4013
Practice Address - Country:US
Practice Address - Phone:360-733-4030
Practice Address - Fax:360-647-7952
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001523133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered