Provider Demographics
NPI:1164298394
Name:DENTE, NICOLE VICTORIA (RDN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:VICTORIA
Last Name:DENTE
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 1:10830 GRANT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-9345
Mailing Address - Country:US
Mailing Address - Phone:619-870-7168
Mailing Address - Fax:
Practice Address - Street 1:10830 GRANT CREEK RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-9345
Practice Address - Country:US
Practice Address - Phone:619-870-7168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-NUTRI-LIC-59683133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered