Provider Demographics
NPI:1881976884
Name:MYERS, NICOLE L (RD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:MYERS
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 1:3 PHILLIPS PL
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-3515
Mailing Address - Country:US
Mailing Address - Phone:917-626-1027
Mailing Address - Fax:413-707-1027
Practice Address - Street 1:25 PRAY ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2110
Practice Address - Country:US
Practice Address - Phone:917-626-1027
Practice Address - Fax:413-707-1027
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT998049133V00000X
NC998049133V00000X
NCL004854133V00000X
MA2910133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered