Provider Demographics
NPI:1073273199
Name:CAMPBELL, NICHOLE (NDTR)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:NDTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:PA
Mailing Address - Zip Code:16059-1340
Mailing Address - Country:US
Mailing Address - Phone:412-310-6882
Mailing Address - Fax:
Practice Address - Street 1:2009 MACKENZIE WAY STE 100
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-5338
Practice Address - Country:US
Practice Address - Phone:412-501-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered