Healthcare Provider Details

I. General information

NPI: 1215749791
Provider Name (Legal Business Name): NILA WILLIAMSON NUTRITION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 MAPLE PARK AVE SE
OLYMPIA WA
98501-2360
US

IV. Provider business mailing address

120 STATE AVE NE # 265
OLYMPIA WA
98501-1131
US

V. Phone/Fax

Practice location:
  • Phone: 360-499-6791
  • Fax:
Mailing address:
  • Phone: 360-499-6791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: NILA WILLIAMSON
Title or Position: OWNER
Credential: RD, IBCLC
Phone: 360-499-6791