Provider Demographics
NPI:1558099374
Name:ROSADO HERNANDEZ, NICOLLE LORRAINE (RDN)
Entity Type:Individual
Prefix:
First Name:NICOLLE
Middle Name:LORRAINE
Last Name:ROSADO HERNANDEZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 CALLE ZIRCONIA
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-2378
Mailing Address - Country:US
Mailing Address - Phone:787-242-2835
Mailing Address - Fax:
Practice Address - Street 1:CARR. 112 KM 1.4 AVE. AGUSTIN RAMOS CALERO
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-242-2835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR86071737133V00000X
PR2199133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist