Provider Demographics
NPI:1568553410
Name:NICHOLS, HELEN BETH (MNT)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:BETH
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MNT
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11735 W HIGHWAY 44
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8619
Mailing Address - Country:US
Mailing Address - Phone:605-343-3986
Mailing Address - Fax:
Practice Address - Street 1:71 CHARLES ST
Practice Address - Street 2:
Practice Address - City:DEADWOOD
Practice Address - State:SD
Practice Address - Zip Code:57732-1303
Practice Address - Country:US
Practice Address - Phone:605-717-6431
Practice Address - Fax:605-719-6471
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0146133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2412779OtherAMERICANS PPO