Provider Demographics
NPI:1467990176
Name:HINDLE, NICOLE (RD)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:HINDLE
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 1:4000 LEGATO RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2893
Mailing Address - Country:US
Mailing Address - Phone:814-574-0910
Mailing Address - Fax:
Practice Address - Street 1:40 BLUEBIRD WAY
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-5902
Practice Address - Country:US
Practice Address - Phone:814-574-0910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86033537OtherCDR