Provider Demographics
NPI:1215040985
Name:HOLLERICH, NICHOL ANN (RD)
Entity Type:Individual
Prefix:MRS
First Name:NICHOL
Middle Name:ANN
Last Name:HOLLERICH
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 1:2054 BORCHERS LANE
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-4102
Mailing Address - Country:US
Mailing Address - Phone:618-628-0350
Mailing Address - Fax:
Practice Address - Street 1:915 N. GRAND BLVD
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered