Provider Demographics
NPI:1942851159
Name:SIDHU, KATHRYN LEE (RDN)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:LEE
Last Name:SIDHU
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:LEE
Other - Last Name:RESKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, IBCLC
Mailing Address - Street 1:1159 SECRET PL
Mailing Address - Street 2:
Mailing Address - City:GREENBANK
Mailing Address - State:WA
Mailing Address - Zip Code:98253-9782
Mailing Address - Country:US
Mailing Address - Phone:765-635-5861
Mailing Address - Fax:
Practice Address - Street 1:1159 SECRET PL
Practice Address - Street 2:
Practice Address - City:GREENBANK
Practice Address - State:WA
Practice Address - Zip Code:98253-9782
Practice Address - Country:US
Practice Address - Phone:765-635-5861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-28
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-306122174N00000X
86075534133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN