Provider Demographics
NPI:1457245326
Name:GORMLEY, NICOLE (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:GORMLEY
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:BIANCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LDN
Mailing Address - Street 1:60 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-6208
Mailing Address - Country:US
Mailing Address - Phone:484-995-3678
Mailing Address - Fax:
Practice Address - Street 1:60 SANDHURST DR
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-6208
Practice Address - Country:US
Practice Address - Phone:484-995-3678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006845133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered