Provider Demographics
NPI:1497064174
Name:ELIAS, NICOLE (RD, LD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ELIAS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9243 W SPRAGUE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-1208
Mailing Address - Country:US
Mailing Address - Phone:440-885-9505
Mailing Address - Fax:
Practice Address - Street 1:9243 W SPRAGUE RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-1208
Practice Address - Country:US
Practice Address - Phone:440-885-9505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6204133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered