Provider Demographics
NPI:1811972102
Name:O'LEARY, NICOLE D (RD LD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:D
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:D
Other - Last Name:SCHLICHTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LD
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-384-8481
Mailing Address - Fax:319-356-8674
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-384-8481
Practice Address - Fax:319-356-8674
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01641133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q55756Medicare UPIN
IAI16400Medicare PIN