Healthcare Provider Details

I. General information

NPI: 1427604412
Provider Name (Legal Business Name): ALICE NICOLE MILLER RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE ST
DOVER DE
19901-3530
US

IV. Provider business mailing address

163 CONTINENTAL DR
DOVER DE
19904-2654
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-4700
  • Fax:
Mailing address:
  • Phone: 302-430-1441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDE-0000767
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: