Provider Demographics
NPI:1023789013
Name:SIEBENMORGEN, ERIC JAMES (RDN)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JAMES
Last Name:SIEBENMORGEN
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:AR
Mailing Address - Zip Code:72855-3017
Mailing Address - Country:US
Mailing Address - Phone:479-518-2069
Mailing Address - Fax:
Practice Address - Street 1:2908 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:AR
Practice Address - Zip Code:72855-3017
Practice Address - Country:US
Practice Address - Phone:479-518-2069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR86253454133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered