Provider Demographics
NPI:1942991153
Name:CLARK-RAMIREZ, NICOLE THERESE (MS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:THERESE
Last Name:CLARK-RAMIREZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ALGERNOURNE ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23664-2102
Mailing Address - Country:US
Mailing Address - Phone:617-548-7930
Mailing Address - Fax:
Practice Address - Street 1:16 ALGERNOURNE ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23664-2102
Practice Address - Country:US
Practice Address - Phone:617-548-7930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist