Provider Demographics
NPI:1336882588
Name:KIRMAYER, ERICA (CNS, LDN)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:KIRMAYER
Suffix:
Gender:F
Credentials:CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13825 BEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95006-9513
Mailing Address - Country:US
Mailing Address - Phone:650-255-4502
Mailing Address - Fax:
Practice Address - Street 1:13825 BEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:BOULDER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95006-9513
Practice Address - Country:US
Practice Address - Phone:650-255-4502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.008706133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist