Healthcare Provider Details

I. General information

NPI: 1194125518
Provider Name (Legal Business Name): NICOLE ESCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE OHAEGBULAM RD, LDN

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 PICARDY AVE PENNINGTON CANCER CENTER
BATON ROUGE LA
70809-3679
US

IV. Provider business mailing address

5215 ESSEN LN STE 200
BATON ROUGE LA
70809-3543
US

V. Phone/Fax

Practice location:
  • Phone: 225-763-4866
  • Fax:
Mailing address:
  • Phone: 225-215-1281
  • Fax: 225-215-1380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1998
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number1998
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: