Provider Demographics
NPI:1376775643
Name:MORRISSEY, NICOLE (RD, CDCES, BC-ADM)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:MORRISSEY
Suffix:
Gender:F
Credentials:RD, CDCES, BC-ADM
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:R
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:3900 HOLLYWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:ST. JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085
Mailing Address - Country:US
Mailing Address - Phone:708-945-4502
Mailing Address - Fax:
Practice Address - Street 1:567 BETTMANN ST
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-3454
Practice Address - Country:US
Practice Address - Phone:740-513-3510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered