Healthcare Provider Details

I. General information

NPI: 1265752018
Provider Name (Legal Business Name): NILA NORINE WILLIAMSON MPH, RD, CD, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NILA NORINE GREGORY

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 12TH AVE NE
OLYMPIA WA
98506-5175
US

IV. Provider business mailing address

323 MAPLE PARK AVE SE
OLYMPIA WA
98501-2360
US

V. Phone/Fax

Practice location:
  • Phone: 360-413-8470
  • Fax: 360-419-5660
Mailing address:
  • Phone: 360-449-6791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-15637
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDI 60043903
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: