Healthcare Provider Details

I. General information

NPI: 1306388624
Provider Name (Legal Business Name): JEANETTE NYCE RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CARROLL ST ATTENTION: ANGIE RUTKOWSKI
SALISBURY MD
21801-5422
US

IV. Provider business mailing address

909 PROGRESS CIR
SALISBURY MD
21804-2323
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-7531
  • Fax: 410-912-4972
Mailing address:
  • Phone: 410-677-1040
  • Fax: 410-912-5748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX3456
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: