1891862801 NPI number — MRS. ELAINE PATRICIA NISONGER RDN, LD

Table of content: DE ANN BUNTING CATC (NPI 1982903845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891862801 NPI number — MRS. ELAINE PATRICIA NISONGER RDN, LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NISONGER
Provider First Name:
ELAINE
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RDN, LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COOMBS
Provider Other First Name:
ELAINE
Provider Other Middle Name:
PATRICIA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891862801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9713 CHISIK CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAGLE RIVER
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99577-8785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-694-4274
Provider Business Mailing Address Fax Number:
907-694-4274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9713 CHISIK CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAGLE RIVER
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99577-8785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-694-4274
Provider Business Practice Location Address Fax Number:
907-694-4274
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  140 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 140 . This is a "DIETITIAN LICENSE" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 210317 . This is a "DMA CERTIFICATION NUMBER" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 918893 . This is a "RD ID NUMBER" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".




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