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NPI Code Detail

MEDICARE: MRS. NICOLE WADE MCLAURIN RD, LD/N

MEDICARE: MRS. NICOLE WADE MCLAURIN RD, LD/N
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133N00000XNutritionist7501FL
2133V00000XRegistered Dietitian86026773FL

General Provider Information

NPI Number : 1598280851
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NICOLE WADE MCLAURIN RD, LD/N
Provider Business Mailing Address
First Line : 631 US HIGHWAY 1 STE 304
Second Line :
City : NORTH PALM BEACH
State : FL
Zip : 33408-4620
Country : US
Telephone Number : 561-465-1400
Fax Number :
Provider Business Practice Location Address
First Line : 7859 LAKE WORTH RD
Second Line :
City : LAKE WORTH
State : FL
Zip : 33467-3225
Country : US
Telephone Number : 561-373-0163
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2017
Last Update Date : 08/08/2017

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