Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 27 3035 | OR |
NPI | 1497820856 |
---|---|
Provider Name | Dr. Sunny Kierstyn |
First Address | Eugene, OR 97401-4113 |
Second Address | Eugene, OR 97401-4113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 04/11/2014 |