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General NPI Number Information
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NPI Number | 1699536458
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Entity Type | Individual
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Provider Name | SIERRA KIM MS
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Gender | Female
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Dates
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Enumeration Date | 01/18/2024
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 1121 WARREN AVE STE 210
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-3572
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Country | US
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Telephone | 630-442-0169
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Fax |
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Provider Business Mailing Address
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Address Line | 461 W VERRET ST
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City | ELMHURST
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State | IL
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Zip | 60126-4936
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Country | US
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Telephone | 512-888-8075
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 164.009732
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License Number State | IL
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