Provider Demographics
NPI:1740548031
Name:KNEE, NICOLE BOISSONNAULT (RD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:BOISSONNAULT
Last Name:KNEE
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 1:50 WASON
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1006
Mailing Address - Country:US
Mailing Address - Phone:413-794-8897
Mailing Address - Fax:413-794-4018
Practice Address - Street 1:50 WASON
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199-1006
Practice Address - Country:US
Practice Address - Phone:413-794-5067
Practice Address - Fax:413-794-7408
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1842133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered