Provider Demographics
NPI:1902371339
Name:JONTONY, NICOLE (RDN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:JONTONY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 E MORRILL AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-1111
Mailing Address - Country:US
Mailing Address - Phone:317-989-7614
Mailing Address - Fax:
Practice Address - Street 1:192 E MORRILL AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1111
Practice Address - Country:US
Practice Address - Phone:317-989-7614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86014897133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered