Provider Demographics
NPI:1811226582
Name:ANDERSON, NICOLE RENEE (RD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 BARING BLVD APT 610
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-6765
Mailing Address - Country:US
Mailing Address - Phone:916-704-0049
Mailing Address - Fax:
Practice Address - Street 1:1855 BARING BLVD APT 610
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-6765
Practice Address - Country:US
Practice Address - Phone:916-704-0049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered