Provider Demographics
NPI:1942898127
Name:THOME, NICOLE (RDN, LD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:THOME
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 N ASHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-6161
Mailing Address - Country:US
Mailing Address - Phone:440-488-0232
Mailing Address - Fax:
Practice Address - Street 1:1903 N ASHWOOD LN
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-6161
Practice Address - Country:US
Practice Address - Phone:440-488-0232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.08743133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered