Provider Demographics
NPI:1972075687
Name:CROTTY, NICOLE (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CROTTY
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:SWENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED DIETITIAN
Mailing Address - Street 1:125 130TH ST SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6401
Mailing Address - Country:US
Mailing Address - Phone:425-224-8200
Mailing Address - Fax:
Practice Address - Street 1:125 130TH ST SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-6401
Practice Address - Country:US
Practice Address - Phone:425-224-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA86030964133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered