Provider Demographics
NPI:1710933809
Name:ECKMAN, NICOLE (RD, CDE)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ECKMAN
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4761
Mailing Address - Country:US
Mailing Address - Phone:207-854-3663
Mailing Address - Fax:207-854-3664
Practice Address - Street 1:201 MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4761
Practice Address - Country:US
Practice Address - Phone:207-854-3663
Practice Address - Fax:207-854-3664
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI789133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0646Medicare ID - Type Unspecified