Provider Demographics
NPI:1932266269
Name:BROWN, NICOLE VERONIQUE (MS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:VERONIQUE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6305 CARDINAL HILL PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2233
Mailing Address - Country:US
Mailing Address - Phone:703-969-6114
Mailing Address - Fax:703-991-1254
Practice Address - Street 1:6305 CARDINAL HILL PL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2233
Practice Address - Country:US
Practice Address - Phone:703-969-6114
Practice Address - Fax:703-991-1254
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI10000023133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
716396OtherDIETITIAN REGISTRATION #
DCDI10000023OtherLICENSE
608347OtherHEALTH FITNESS CERTIFICAT