Provider Demographics
NPI:1932306800
Name:NICHOLS, MINDY (RD, CDE)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:NICHOLS
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 1:1917 N STEELE ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-8200
Mailing Address - Country:US
Mailing Address - Phone:253-394-4383
Mailing Address - Fax:
Practice Address - Street 1:1424 MASON ST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-2008
Practice Address - Country:US
Practice Address - Phone:253-394-4383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86074133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered