Provider Demographics
NPI:1881335875
Name:SEIBOLD, CHRISTINA (CN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:SEIBOLD
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 NE 145TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-8908
Mailing Address - Country:US
Mailing Address - Phone:360-513-8962
Mailing Address - Fax:
Practice Address - Street 1:2906 NE 145TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-8908
Practice Address - Country:US
Practice Address - Phone:360-513-8962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU61237543133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANU61237543OtherWASHINGTON STATE DEPARTMENT OF HEALTH