Individual
KALLIE MARIE SIDEREWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
5301 E GRANT RD, TUCSON, AZ 85712-2805
(520) 730-1582
Mailing address
PO BOX 31235, TUCSON, AZ 85751-1235
(520) 324-4100
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86009790
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220882
—
AZ
01
—
86009790
RDN CERTIFICATE
AZ
Enumeration date
11/30/2016
Last updated
09/14/2021
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