Provider Demographics
NPI:1205675311
Name:VICARIO, MONIKA ISABELLA (RD, LDN)
Entity type:Individual
Prefix:
First Name:MONIKA
Middle Name:ISABELLA
Last Name:VICARIO
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:MONIKA
Other - Middle Name:ISABELLA
Other - Last Name:HARTL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:213 SHALLOWBAG BAY LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-0167
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:213 SHALLOWBAG BAY LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-0167
Practice Address - Country:US
Practice Address - Phone:919-985-0812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007885133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered