Provider Demographics
NPI:1144704883
Name:RANDOLPH, NIKOLE J (MS, RDN)
Entity type:Individual
Prefix:MRS
First Name:NIKOLE
Middle Name:J
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:MRS
Other - First Name:NIKI
Other - Middle Name:
Other - Last Name:RANDOLPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RDN
Mailing Address - Street 1:665 FOSSIL BED CIR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-5432
Mailing Address - Country:US
Mailing Address - Phone:720-939-8234
Mailing Address - Fax:
Practice Address - Street 1:665 FOSSIL BED CIR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-5432
Practice Address - Country:US
Practice Address - Phone:720-939-8234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered