Provider Demographics
NPI:1558067173
Name:ICHIM, FRANCINE (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:FRANCINE
Middle Name:
Last Name:ICHIM
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:FRANCINE
Other - Middle Name:
Other - Last Name:OLAIRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1027 ARBOR LAKE WALK
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-3497
Mailing Address - Country:US
Mailing Address - Phone:949-370-0173
Mailing Address - Fax:
Practice Address - Street 1:1027 ARBOR LAKE WALK
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-3497
Practice Address - Country:US
Practice Address - Phone:949-370-0173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD006292133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered