Healthcare Provider Details

I. General information

NPI: 1982727533
Provider Name (Legal Business Name): NANCY LEE NEVIN-FOLINO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1898
US

IV. Provider business mailing address

1356 SCENICVIEW CT
DAYTON OH
45459-4940
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3211
  • Fax: 937-641-5446
Mailing address:
  • Phone: 937-434-6396
  • Fax: 937-641-5446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1961
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: