Healthcare Provider Details

I. General information

NPI: 1700245222
Provider Name (Legal Business Name): SUANNE FAITH SIKKEMA M.S., C.N.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W 2ND AVE SUITE 100
ANCHORAGE AK
99501-2151
US

IV. Provider business mailing address

PO BOX 91014
ANCHORAGE AK
99509-1014
US

V. Phone/Fax

Practice location:
  • Phone: 907-830-9877
  • Fax:
Mailing address:
  • Phone: 907-830-9877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: