Healthcare Provider Details

I. General information

NPI: 1801843651
Provider Name (Legal Business Name): NICOLE PATIENCE MS RD LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 N BETHLEHEM PIKE
LOWER GWYNEDD PA
19002-2655
US

IV. Provider business mailing address

1604 HAMPTON RD
HAVERTOWN PA
19083-2506
US

V. Phone/Fax

Practice location:
  • Phone: 215-283-2833
  • Fax:
Mailing address:
  • Phone: 610-789-0367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN003255
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: