Provider Demographics
NPI:1205173648
Name:NILES, HOLLY J (MS)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:J
Last Name:NILES
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 1:89 LANCASTER RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1525
Mailing Address - Country:US
Mailing Address - Phone:860-266-5866
Mailing Address - Fax:
Practice Address - Street 1:89 LANCASTER RD
Practice Address - Street 2:SUITE 9
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1525
Practice Address - Country:US
Practice Address - Phone:860-266-5866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2016-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist