Provider Demographics
NPI:1083986061
Name:BOLING, NICOLE C (RD)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:C
Last Name:BOLING
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 RIVERLAND DR
Mailing Address - Street 2:APT. 3
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-2454
Mailing Address - Country:US
Mailing Address - Phone:260-341-2313
Mailing Address - Fax:
Practice Address - Street 1:8301 RIVERLAND DR
Practice Address - Street 2:APT. 3
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-2454
Practice Address - Country:US
Practice Address - Phone:260-341-2313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1046212133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered