Provider Demographics
NPI:1669865028
Name:STAHR, NICOLE (RD LD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:STAHR
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 1:1420 NW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-7838
Mailing Address - Country:US
Mailing Address - Phone:515-829-1607
Mailing Address - Fax:
Practice Address - Street 1:2540 E EUCLID AVE
Practice Address - Street 2:DES MOINES HY-VEE #1138
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50317-6046
Practice Address - Country:US
Practice Address - Phone:515-262-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01566133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered