Provider Demographics
NPI:1255151569
Name:NOLTER, ANTONIA MARIE GALASSO (RD, LDN)
Entity type:Individual
Prefix:
First Name:ANTONIA
Middle Name:MARIE GALASSO
Last Name:NOLTER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:ANTONIA
Other - Middle Name:MARIE
Other - Last Name:GALASSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1388 BEAVER RUN DR
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-9532
Mailing Address - Country:US
Mailing Address - Phone:570-225-1602
Mailing Address - Fax:
Practice Address - Street 1:1388 BEAVER RUN DR
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-9532
Practice Address - Country:US
Practice Address - Phone:570-225-1602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN008767133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered