Provider Demographics
NPI:1073982047
Name:NUZZOLO, THERESE MCCONNELL (RDN)
Entity Type:Individual
Prefix:MS
First Name:THERESE
Middle Name:MCCONNELL
Last Name:NUZZOLO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BREED HILL RD
Mailing Address - Street 2:NUZZOLO NUTRITION
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3733
Mailing Address - Country:US
Mailing Address - Phone:860-888-9864
Mailing Address - Fax:
Practice Address - Street 1:26 BREEDS HILL RD
Practice Address - Street 2:NUZZOLO NUTRITON
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-3733
Practice Address - Country:US
Practice Address - Phone:860-888-9864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001364133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered