Provider Demographics
NPI:1609542307
Name:NILAN, MICHELLE (CNS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:NILAN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 SIERRA VISTA DR APT 207
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-9344
Mailing Address - Country:US
Mailing Address - Phone:818-983-4395
Mailing Address - Fax:818-341-4836
Practice Address - Street 1:995 SIERRA VISTA DR APT 207
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-9344
Practice Address - Country:US
Practice Address - Phone:818-983-4395
Practice Address - Fax:818-341-4836
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-21
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CNS18250133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist