Provider Demographics
NPI:1346927951
Name:EDDIE, NIA MARIE MYLIKA (RD)
Entity Type:Individual
Prefix:MISS
First Name:NIA MARIE
Middle Name:MYLIKA
Last Name:EDDIE
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 1:12600 DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-1781
Mailing Address - Country:US
Mailing Address - Phone:239-728-8558
Mailing Address - Fax:
Practice Address - Street 1:12600 DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-1781
Practice Address - Country:US
Practice Address - Phone:239-728-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered