Provider Demographics
NPI:1376297762
Name:NICHOLSON, ANDREA (BCHN, NTM, RWP-1)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:BCHN, NTM, RWP-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14993 MUNICH AVE
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-6068
Mailing Address - Country:US
Mailing Address - Phone:303-815-8108
Mailing Address - Fax:
Practice Address - Street 1:14993 MUNICH AVE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-6068
Practice Address - Country:US
Practice Address - Phone:303-815-8108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist