Provider Demographics
NPI:1689237372
Name:NICOLETTE, ALEXANDRA MARIE (MS, RD, CDN)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:MARIE
Last Name:NICOLETTE
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-6230
Mailing Address - Country:US
Mailing Address - Phone:315-351-2622
Mailing Address - Fax:315-215-2920
Practice Address - Street 1:2615 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-6230
Practice Address - Country:US
Practice Address - Phone:315-351-2622
Practice Address - Fax:315-215-2920
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009966133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered