Provider Demographics
NPI:1225274301
Name:FORD, NICOLE ANN (MA, RD, LMNT)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ANN
Last Name:FORD
Suffix:
Gender:F
Credentials:MA, RD, LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 N. 27TH ST
Mailing Address - Street 2:HY-VEE
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521
Mailing Address - Country:US
Mailing Address - Phone:402-477-4764
Mailing Address - Fax:402-477-1802
Practice Address - Street 1:5020 N. 27TH ST
Practice Address - Street 2:HY-VEE
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521
Practice Address - Country:US
Practice Address - Phone:402-477-4764
Practice Address - Fax:402-477-1802
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE695133V00000X
NE133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered