Provider Demographics
NPI:1073702734
Name:CORMIER, NICOLE MARIE (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MARIE
Last Name:CORMIER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 RT 6A UNIT 1
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653-2464
Mailing Address - Country:US
Mailing Address - Phone:508-813-9282
Mailing Address - Fax:
Practice Address - Street 1:82 RT 6A UNIT 1
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-2464
Practice Address - Country:US
Practice Address - Phone:508-813-9282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA927341133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
042297845OtherPHCS/MULTI-PLAN
042297845OtherGREAT WEST HEALTH CARE
MASS0062OtherBCBSMA
MA000860901OtherMEDICARE
1073702734OtherFALLON COMMUNITY HEALTH PLAN