Provider Demographics
NPI:1376775643
Name:MORRISSEY, NICOLE R (MS, RD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:MORRISSEY
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:R
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:955 S BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090-6743
Mailing Address - Country:US
Mailing Address - Phone:269-637-5271
Mailing Address - Fax:
Practice Address - Street 1:567 BETTMANN ST
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-3454
Practice Address - Country:US
Practice Address - Phone:740-513-3510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-19
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered