Healthcare Provider Details

I. General information

NPI: 1962110395
Provider Name (Legal Business Name): NICOLE HODAC MS, RDN, CSO, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 NANTUCKET DR
LEWIS CENTER OH
43035-8969
US

IV. Provider business mailing address

3020 NANTUCKET DR
LEWIS CENTER OH
43035-8969
US

V. Phone/Fax

Practice location:
  • Phone: 937-422-5395
  • Fax:
Mailing address:
  • Phone: 937-422-5395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License NumberDT83860
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT83860
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: