Provider Demographics
NPI:1659880730
Name:SWEENEY, NINA MARIE I (NC)
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:MARIE
Last Name:SWEENEY
Suffix:I
Gender:F
Credentials:NC
Other - Prefix:MS
Other - First Name:NINA
Other - Middle Name:MARIE
Other - Last Name:SWEENEY
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:30100 TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2064
Mailing Address - Country:US
Mailing Address - Phone:949-300-2204
Mailing Address - Fax:
Practice Address - Street 1:3500 BAHIA BLANCA W
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-2924
Practice Address - Country:US
Practice Address - Phone:949-300-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ$$$$$$$$$OtherGOV
$$$$$$$$$OtherSOCIAL SECURITY