Provider Demographics
NPI:1871786178
Name:SEEGER, SHIRLEY (RD)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:SEEGER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2613 NONOHE ST
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-2842
Mailing Address - Country:US
Mailing Address - Phone:808-621-2826
Mailing Address - Fax:
Practice Address - Street 1:98-1005 MOANALUA RD
Practice Address - Street 2:STE. 420, CKD SERVICES OF PEARLRIDGE
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4777
Practice Address - Country:US
Practice Address - Phone:808-440-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL726692133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIBG503ZMedicare UPIN
HI102839Medicare UPIN