MEDICARE: MS. NICOLE VERONIQUE BROWN M.S., R.D., L.D.

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
1	133V00000X	Registered Dietitian	DI10000023	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	716396	OTHER		DIETITIAN REGISTRATION #
2	DI10000023	OTHER	DC	LICENSE
3	608347	OTHER		HEALTH FITNESS CERTIFICAT

General Provider Information

NPI Number	:	1932266269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE VERONIQUE BROWN M.S., R.D., L.D.

Provider Business Mailing Address
First Line	:	6305 CARDINAL HILL PL
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-2233
Country	:	US
Telephone Number	:	703-969-6114
Fax Number	:	703-991-1254

Provider Business Practice Location Address
First Line	:	6305 CARDINAL HILL PL
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-2233
Country	:	US
Telephone Number	:	703-969-6114
Fax Number	:	703-991-1254

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/08/2007

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