Provider Demographics
NPI:1255949376
Name:FINKEN, NICOLE (RD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FINKEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 FULLER LN
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-4213
Mailing Address - Country:US
Mailing Address - Phone:781-812-4803
Mailing Address - Fax:
Practice Address - Street 1:2121 N PEARL ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-2492
Practice Address - Country:US
Practice Address - Phone:281-948-8014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered