Provider Demographics
NPI:1578984878
Name:CUGINI, NICOLE MARIE (RD, LD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:CUGINI
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 1:2250 LEESTOWN RD
Mailing Address - Street 2:120 LD
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2250 LEESTOWN RD
Practice Address - Street 2:120 LD
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-1052
Practice Address - Country:US
Practice Address - Phone:614-824-0532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-04
Last Update Date:2014-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD7323133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered