Healthcare Provider Details

I. General information

NPI: 1700066909
Provider Name (Legal Business Name): NICOLE L STARR RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 HARRISBURG PIKE SUITE 300
LANCASTER PA
17601-2644
US

IV. Provider business mailing address

2150 HARRISBURG PIKE SUITE 300
LANCASTER PA
17601-2644
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-2935
  • Fax: 717-544-3935
Mailing address:
  • Phone: 717-544-2935
  • Fax: 717-544-3935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN000016
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: