Provider Demographics
NPI:1841976982
Name:NIELSON, SABRINA (RD)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:NIELSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:
Other - Last Name:SAMUELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 5299
Mailing Address - Street 2:MS: 820-5-PCO
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0299
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15533 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-9251
Practice Address - Country:US
Practice Address - Phone:509-530-4260
Practice Address - Fax:509-530-4261
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI61488847133V00000X
IDD-1331133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered