Provider Demographics
NPI:1942595400
Name:DANN-PAYNE, NICOLE VICTORIA (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:VICTORIA
Last Name:DANN-PAYNE
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2032
Mailing Address - Country:US
Mailing Address - Phone:570-994-4066
Mailing Address - Fax:
Practice Address - Street 1:714 PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3955
Practice Address - Country:US
Practice Address - Phone:570-994-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004515133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered