Provider Demographics
NPI:1710676986
Name:CIRRENCIONE, NICOLE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CIRRENCIONE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-2894
Mailing Address - Country:US
Mailing Address - Phone:815-592-4259
Mailing Address - Fax:
Practice Address - Street 1:1741 PHEASANT LN
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2894
Practice Address - Country:US
Practice Address - Phone:815-592-4259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.008782133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered