Provider Demographics
NPI:1306388624
Name:NYCE, JEANETTE (RDN)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:NYCE
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 1:909 PROGRESS CIR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2323
Mailing Address - Country:US
Mailing Address - Phone:410-677-1040
Mailing Address - Fax:410-912-5748
Practice Address - Street 1:100 E CARROLL ST
Practice Address - Street 2:ATTENTION: ANGIE RUTKOWSKI
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5422
Practice Address - Country:US
Practice Address - Phone:410-543-7531
Practice Address - Fax:410-912-4972
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3456133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered