Provider Demographics
NPI:1467163816
Name:BECKER, NICOLE AMBER (RD, LDN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:AMBER
Last Name:BECKER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 RIVER BIRCH CT APT 526
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5142
Mailing Address - Country:US
Mailing Address - Phone:732-948-9847
Mailing Address - Fax:
Practice Address - Street 1:2551 N CLARK ST STE 400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7725
Practice Address - Country:US
Practice Address - Phone:312-533-1754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered