Provider Demographics
NPI:1407600638
Name:BAKER, NICOLE OLIVIA (MS, RDN, CNSC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:OLIVIA
Last Name:BAKER
Suffix:
Gender:F
Credentials:MS, RDN, CNSC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:OLIVIA
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN, CNSC
Mailing Address - Street 1:164 THELMA DR
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-7831
Mailing Address - Country:US
Mailing Address - Phone:269-924-6905
Mailing Address - Fax:
Practice Address - Street 1:164 THELMA DR
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-7831
Practice Address - Country:US
Practice Address - Phone:269-924-6905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86143610133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered