Provider Demographics
NPI:1134963127
Name:COLE, ABRAE JADE (NBHWC, LN)
Entity type:Individual
Prefix:MISS
First Name:ABRAE JADE
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:NBHWC, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-4706
Mailing Address - Country:US
Mailing Address - Phone:307-250-3383
Mailing Address - Fax:
Practice Address - Street 1:1831 16TH ST
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4706
Practice Address - Country:US
Practice Address - Phone:307-250-3383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 133NN1002X, 174400000X
A-3196281171400000X
WANU61579899133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171400000XOther Service ProvidersHealth & Wellness Coach
No174400000XOther Service ProvidersSpecialist