Provider Demographics
NPI:1245547389
Name:CELONA-JACOBS, NICOLE (MS RD CDE)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CELONA-JACOBS
Suffix:
Gender:F
Credentials:MS RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 W 2ND PL
Mailing Address - Street 2:STE 410
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1711
Mailing Address - Country:US
Mailing Address - Phone:720-321-8460
Mailing Address - Fax:720-321-8461
Practice Address - Street 1:11600 W 2ND PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1527
Practice Address - Country:US
Practice Address - Phone:720-321-8316
Practice Address - Fax:720-321-8301
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered