Healthcare Provider Details

I. General information

NPI: 1811583826
Provider Name (Legal Business Name): NICOLE FEEHERY-ALPUERTO MS, CNS, LN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5923 W 8TH ST
DULUTH MN
55807-1222
US

IV. Provider business mailing address

5923 W 8TH ST
DULUTH MN
55807-1222
US

V. Phone/Fax

Practice location:
  • Phone: 214-562-8544
  • Fax:
Mailing address:
  • Phone: 214-562-8544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberN237
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberN237
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: