Provider Demographics
NPI:1902084254
Name:GEPNER, NIKKI (RDN)
Entity Type:Individual
Prefix:MRS
First Name:NIKKI
Middle Name:
Last Name:GEPNER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 821092
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-0999
Mailing Address - Country:US
Mailing Address - Phone:425-588-0480
Mailing Address - Fax:
Practice Address - Street 1:19125 N CREEK PKWY STE 120
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-8000
Practice Address - Country:US
Practice Address - Phone:425-588-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001950133V00000X
WA940982133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered