Provider Demographics
NPI:1770175267
Name:NICKELL, SZOFIA ARIANA (DTR)
Entity type:Individual
Prefix:
First Name:SZOFIA
Middle Name:ARIANA
Last Name:NICKELL
Suffix:
Gender:F
Credentials:DTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 NW 122ND ST APT 2222
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8415
Mailing Address - Country:US
Mailing Address - Phone:817-894-6296
Mailing Address - Fax:
Practice Address - Street 1:2201 NW 122ND ST APT 2222
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8415
Practice Address - Country:US
Practice Address - Phone:817-894-6296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered