Provider Demographics
NPI:1336422245
Name:LARIZZA, NICOLE C (MS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:C
Last Name:LARIZZA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 ELK TER
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4313
Mailing Address - Country:US
Mailing Address - Phone:203-520-8484
Mailing Address - Fax:
Practice Address - Street 1:59 ELK TER
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4313
Practice Address - Country:US
Practice Address - Phone:203-520-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist