Provider Demographics
NPI:1245594712
Name:HOLOVACH, NICOLE FERRING (MS, RD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:FERRING
Last Name:HOLOVACH
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ELIZABETH
Other - Last Name:FERRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21785 FILIGREE CT
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6213
Mailing Address - Country:US
Mailing Address - Phone:703-554-1100
Mailing Address - Fax:
Practice Address - Street 1:21785 FILIGREE CT
Practice Address - Street 2:SUITE 203
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6213
Practice Address - Country:US
Practice Address - Phone:703-554-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3323133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered